心间隔缺损并双向分流患儿的围术期治疗

The treatment of children suffering cardiac septal defects with double direct shunt

目的 提高重症先天性心脏病患儿的成活率。方法 随机选择 32例拟行手术治疗的心间隔缺损并重度肺动脉高压、双向分流的患儿为研究对象。年龄 4个月～ 12岁 ,平均 4 3岁 ,体重 4 5～ 2 7kg ,平均 9 6kg,≤2岁者 18例 ,>2岁者 14例 ;单纯室间隔缺损 16例 ,室间隔 +房间隔缺损 5例 ,室间隔缺损 +动脉导管未闭 7例 ,室间隔缺损 +房间隔缺损 +动脉导管未闭 3例 ,完全性心内膜垫缺损 1例。术前采用合适的药物治疗 ,控制肺动脉压达满意水平 10～ 15d ,术后坚持使用药物治疗的同时延长呼吸机辅助时间 ,以维持适宜的血气指标在满意的水平。结果 本组 32例 ,治愈 2 9例 ,术后并发肺高压危象 9例 ,右心功能衰竭 3例 ,频发室性早搏 3例 ,低心输出量综合征 4例 ,共死亡 3例。结论 对心间隔缺损并重度肺动脉高压。

Objective Improve the cure rate of the children with severe congenital heart diseases.Methods Thirty two cases who suffered from congenital cardiac septal defects with severe pulmonary hypertension and double direct shunt between two ventricules were selected at random as subjects.Their ages were 4 months to 12 years (mean 4 3) and the weight,4 5 to 27 kilogrames (mean 9 6).Among the patients,18 cases aged 2 years or below and 14 cases above 2 years.Isloated ventricular septal defect(VSD),VSD+atrial septal defect(ASD),VSD+patent ductus arteriosus(PDA),and VSD+ASD+PDA were of 16,5,7 and 3 cases respectively.Only one case belonged to TECD.Before operation a suitable medication was used to control their pulmonary arterial pressure (PAP) to a satisfied level for 10 to 15 days.A continued postoperative medication with a prolonged mechanical ventilation aid had been used in order to be sure that the PaO 2,PaCO 2 and pH were at a satisfied level.Result Of the 32 cases,29 were cured;pulmonary hypertension crisis (PHC),the right heart failure,and frequent ventricular premature beat were in 9,3,3 cases respectively;lower cardiac output syndrome was in 4 cases.Three cases died.Conclusion For the patients with severe pulmonary hypertension and double direct shunt,a suitable perioperative combination treatment is very important to improve the operative success rate.