1岁以下婴儿室间隔缺损伴肺动脉高压的外科治疗

Surgical treatment of ventricular septal defect with pulmonary hypertension in infants younger than 1 year old

目的 探讨婴儿室间隔缺损 (VSD)伴肺动脉高压 (PH)外科治疗的结果和经验。方法 对 6 0例 1岁以下婴儿室缺伴肺高压的手术治疗进行总结。年龄 2～ 11个月 ,平均 (6 2 3± 2 6 0 )个月 ,体重 3～ 10kg,平均 (5 5 0± 1 2 6 )kg。术前中度以上肺高压 5 3例 (88 8% )。结果 全组手术死亡3例 (5 % ) ,手术死亡的主要原因是肺动脉高压危象和急性心包填塞。术后主要并发症为肺动脉高压危象 ,术后出血和肺部感染。结论 婴儿室缺伴肺高压应尽早手术治疗。术前、术后支持疗法 ,术中加强心肌保护、提高手术技巧 ,术后注意呼吸、循环监测 ,加强呼吸道管理 ,防治可能出现的并发症是手术治疗成功的关键。

Objective To review the experience of surgical treatment of ventricular septal defect (VSD) with pulmonary hypertension (PH) in infants younger than 1 year old.Methods 60 infants with VSD+PH received operations. Their ages ranged from 2 to 11 months[(6.23±2 60) months]. The mean body weight was [(5.50±1.26)kg]. 53 patients (88.8%) had moderate or severe pulmonary hypertension before operation.Results Three patients died after operation. The operative mortality was 5%. The main reasons were pulmonary hypertensive crisis and acute cardiac tamponade. The main complications were pulmonary hypertensive crisis, bleeding and pulmonary infection. Conclusion Surgical treatment of VSD with PH in infants may have a satisfactory outcome. The improvement of surgical techniques and proper perioperative management are important factors influencing surgical outcome.