室间隔缺损患儿合理手术年龄的探索

Study on the optimal age for surgical repair of ventricular septal defect in children

目的总结单纯室间隔缺损患者围手术期情况,评估室间隔缺损的最适手术时机。方法收集2014年7月至2017年12月所有简单室间隔缺损患儿手术情况,短期预后和医疗费用,分析其最佳手术年龄。结果本研究最终纳入2263例患儿,分为<3月,≥3~<6月,≥6~<12月,≥1~<3岁和≥3岁以上5个年龄阶段。分析显示,6个月以下患儿体外循环转流时间和主动脉阻断时间都明显高于6个月以上患儿,1岁以下患儿术后ICU时间和住院时间都明显高于1岁以上患儿,6个月以下患儿的住院费用显著高于6个月以上患儿。在并发症中3个月以下患儿感染发生率最高。其余并发症如脑出血、肺高压危象等各组间虽有统计学差异,但发生率低,临床意义不明显。结论根据本组室间隔缺损患儿的围手术期资料,建议单纯室间隔缺损患儿手术时间以1岁左右为宜。

Objective To summarize the perioperative status of patients with ventricular septal defect and to evaluate the optimal surgical time. Methods Surgical status, short-term prognosis and medical expenses of all children with simple ventricular septal defect from July 2014 to December 2017 were collected and analyzed. Results The study enrolled 2263 children, who were divided into 0-3 months old, 3-6 months old, 6-12 months old, 1-3 years old and over 3 years age groups. The analysis showed that the extracorporeal circulation time and aortic occlusion time were significantly longer in groups under 6 months. The postoperative ICU stay and hospitalization time were significantly longer in children under 1 year old. The cost of hospitalization for children under 6 months old was significantly higher than that for children over 6 months old. The incidence of post-operative infection was highest in children under 3 months old. The incidences of complications such as cerebral hemorrhage and pulmonary hypertension were low but significantly different among the groups. Conclusion According to the analysis of the perioperative operation status, prognosis and cost, it is recommended that the optimal surgical time for children with simple ventricular septal defect should be about 1 year old.