体外循环下室间隔缺损修补术同期纤支镜灌洗治疗小儿室间隔缺损并重症肺炎的疗效分析

Effect of ventricular septal defect repair under cardiopulmonary bypass and bronchofiberscope lavage in the treatment of ventricular septal defect and severe pneumonia in children

目的探讨体外循环下室间隔缺损修补术同期纤支镜灌洗治疗小儿室间隔缺损并重症肺炎的临床效果。方法选取室间隔缺损并重症肺炎患儿20例,按照随机数字表法分为对照组(10例)和观察组(10例)。对照组实施常规治疗+体外循环下室间隔缺损修补术,观察组实施常规治疗+体外循环下室间隔缺损修补术+纤支镜灌洗。对比2组患儿体外循环时间、主动脉阻断时间、呼吸机辅助治疗时间、住院时间等手术相关指标,检测2组患儿治疗前、治疗后1个月及治疗后3个月的心功能与肺功能指标变化,统计2组患儿治疗后3个月的并发症发生率和病死率。结果2组患儿体外循环时间、主动脉阻断时间比较差异均无统计学意义(P>0.05),观察组呼吸机辅助治疗时间、住院时间均短于对照组(P<0.05)。2组患儿治疗后1个月及治疗后3个月的左心室射血分数(LVEF)、二尖瓣E峰/A峰(E/A)、动态顺应性和氧合指数均高于治疗前(P<0.05),左心室收缩时间间期(LVSTI)和呼吸做功均低于治疗前(P<0.05),治疗后3个月的心、肺功能指标与同组治疗后1个月比较差异均无统计学意义(P>0.05);观察组治疗后1个月及治疗后3个月的LVEF、E/A、动态顺应性和氧合指数均高于对照组(P<0.05),LVSTI和呼吸做功均低于对照组(P<0.05)。观察组治疗后3个月的并发症总发生率低于对照组(P<0.05),2组患儿病死率比较差异无统计学意义(P>0.05)。结论采用体外循环下室间隔缺损修补术同期纤支镜灌洗治疗小儿室间隔缺损并重症肺炎可改善患儿心肺功能,减少并发症,缩短患儿康复时间。

Objective To investigate the clinical effect of ventricular septal defect repair under cardiopulmonary bypass and broncho-fiberscope lavage in the treatment of ventricular septal defect and severe pneumonia in children.Methods A total of 20 children with ventricular septal defect and severe pneumonia were selected and divided into the control group(10 cases)and the observation group(10 cases)according to the random number table method.Children in the control group were treated with conventional therapy+ventricular septal defect repair under cardiopulmonary bypass,and those in the observation group were treated with conventional therapy+ventricular septal defect repair under cardiopulmonary bypass+bronchofiberscope lavage.The surgery related indicators including the cardiopulmonary bypass time,aortic occlusion time,duration of ventilator-assisted treatment,hospital stay,etc.in the two groups were compared.The changes of cardiac function and pulmonary function parameters before treatment,1 month and 3 months after treatment in the two groups were compared.The incidences of complications and case fatality 3 months after treatment in the two groups were counted.Results There was no statistically significant difference in the cardiopulmonary bypass time or aortic occlusion time between the two groups(P>0.05).The duration of ventilator-assisted treatment and hospital stay in the observation group were shorter than those in the control group(P<0.05).The left ventricular ejection fraction(LVEF),mitral value E peak/A peak(E/A),dynamic compliance and oxygenation index 1 month and 3 months after treatment in the two groups were higher than those before treatment(P<0.05),while the left ventricular systolic time interval(LVSTI)and respiratory work were lower than those before treatment(P<0.05).There was no statistically significant difference in the cardiopulmonary function parameters between 3 months and 1 month after treatment in the same group(P<0.05).The LVEF,E/A,dynamic compliance and oxygenation index of the observation group 1 month and 3 months after treatment were higher than those of the control group(P<0.05),while the LVSTI and respiratory work of the observation group were lower than those of the control group(P<0.05).The total incidence of complications 3 months after treatment in the observation group was lower than that in the control group(P<0.05),and there was no statistically significant difference in case fatality between the two groups(P>0.05).Conclusion Ventricular septal defect repair under cardiopulmonary bypass and bronchofiberscope lavage in the treatment of ventricular septal defect and severe pneumonia in children can improve the cardiopulmonary function,reduce the complications and shorten the recovery time.