幼儿先天性心脏病伴肺动脉高压的外科治疗

Surgical Treatment of Congenital Heart Disease with Pulmonary Hypertension in Infant

目的：先天性心脏病伴有肺动脉高压（ＰＨ）是婴幼儿期常见的并发症，尽早手术纠正心内畸形，阻断分流可防止病情进一步恶化。方法：自１９８６ 年８ 月至１９９８ 年５ 月，共收治６ 周岁以下患儿５７ 例，男３４ 例，女２３ 例，年龄２～６ 岁，其中动脉导管未闭（ＰＤＡ）６ 例，房间隔缺损（ＡＳＤ）１４ 例，室间隔缺损（ＶＳＤ）３１ 例，ＶＳＤ合并ＰＤＡ １例，ＶＳＤ合并ＡＳＤ ５例。患儿肺动脉平均压６．６７～９．３ｋＰａ（１ｋＰａ＝ ７．５ ｍ ｍ Ｈｇ），安静状态下血氧饱和度（ＳａＯ２）大于９５％ ，５ 例患儿活动后ＳａＯ２ 降至８８％ ～９５％ 。５７例患儿中５１ 例在体外循环下行心内修补术。结果：手术死亡５ 例，死亡率８．８％ 。结论：为阻止先天性心脏病合并ＰＨ 的发生和病情的恶化，必须对幼儿期先天性心脏病行早期手术治疗，才可预防肺动脉高压的发生和心肺功能衰竭。应严格掌握手术时机和适应证，保护心肺功能，预防术后发生肺动脉高压危象，其诱因多和缺氧有关，致肺血管痉挛。

Objective: Congenital heart diseases with pulmonary hypertension are not rare in infants. Malformation of the heart must be repaired by operation earlier to cut off the shunt in order to guard against the worsening of the disease. Method: From August 1986 to May 1998, fifty seven patients with age less than six years old were underwent surgical treatment; 34 boys and 23 girls; age: two to six years old. Among them the diagnosis included patent ductus arteriosus (PDA) 6 patients、atrial septal defect (ASD) 14、ventricular septal defect (VSD) 31、VSD+PDA I and VSD+ASD 5. Mean blood pressure of the pulmonary artery showed 6.67 to 9.3 kPa (1kPa=7.5 mmHg), SaO\-2 saturation was more than 95% at rest and dropped to 88%～95% after exercise in 5 patients. 51 cases among these infants were repaired for heart malformation with extracorporeal circulation. Results: Five patients died during the operative period, fatality rate was 8.8%. Conclusion: Surgical treatment of congenital heart disease with pulmonary hypertension in infants should be performed as earlier as possible, only thus may prevent progression of the pulmonary hypertension and cardiopulmonary failure. The surgery should seriously control the operative time, grasp the operative indication and appropriately protect the heart and lung function. Precautions against pulmonary hypertensive crisis should be taken place. Remote causes related to oxygen deficit, led to pulmonary vascular spasm, enabled sudden deterioration of patient's disease.