3月龄以下婴儿室间隔缺损右腋下切口急诊手术外科治疗32例经验总结

Ventricular Septal Defect Babies Under 3 Months Right Subaxillary Incision Surgical Treatment Experience of 32 Cases of Emergency Management

目的探讨3月龄以下婴儿室间隔缺损合并肺炎急诊手术外科治疗适应证，手术技术及围手术期处理。方法回顾性分析2014年1月～2014年6月，3月龄以下合并肺炎室间隔缺损行急诊手术32例，均采用右腋下切口。其中28例带呼吸机，合并动脉导管未闭11例，合并卵圆孔未闭23例，均合并肺动脉高压，均在全麻低温体外循环下行室缺修补术及同期合并畸形矫治术。结果全组术后早期死亡1例，死亡率3.1%，术后心率失常4例，肺高压危象2例，低心排3例，气胸8例，给予对症处理后痊愈出院，残余分流5例。分流口均小于2〈br〉 mm，随访1月，3月超声心动图已自动痊愈，生长发育良好。结论3月龄以下婴儿室间隔缺损合并肺炎行急诊手术采用右腋下切口效果良好，而准确把握手术的适应证，提高手术技术操作和加强围手术期处理是成功的关键。

Objective To investigate the emergency operation in ventricular septal defect combined pneumonia babies under 3 months surgical indications, surgical technique and perioperative treatment. Methods A retrospective analysis in January 2014 to June 2014, during the period of 3 months following merger pneumonia 32 cases of ventricular septal defect underwent emergency surgery, adopt right subaxillary incision. 28 cases with breathing machine, merge artery catheter was not shut in 11 cases, 23 cases of combination of patent foramen ovale, merge pulmonary hypertension, in low temperature under extracorporeal circulation of general anesthesia room repair deficiency and at the same time combined surgery deformity correction. Results The whole set of early postoperative death in 1 case, 3.1% mortality rate, postoperative arrhythmia in 4 cases, 2 cases of pulmonary hypertension crisis and low cardiac 3 cases, 8 cases of pneumothorax, to suit the recovered after treatment, the residual shunt in 5 cases. FenLiuKou are less than 2 mm, followed up for 1 month, 3 months echocardiography has automatic recovery, growth and development is good. Conclusion Ventricular septal defect combined babies under 3 months pneumonia underwent emergency surgery using right subaxillary incision effect is good, and accurately grasp the indications for surgery, improve the technical operation and strengthen the perioperative treatment is the key to success.