低体重婴儿室间隔缺损并肺动脉高压外科治疗

Surgical treatment of ventricular septal defect with pulmonary hypertension in low body-weight infants

目的总结连续57例体重小于5kg婴儿室间隔缺损并肺动脉高压(VSD+PH)外科治疗经验。方法1998-03～2003-03手术治疗5kg以下婴儿VSD+PH57例,术前给予强心、利尿、扩血管治疗,长时间对症治疗心衰仍无改善者行急症手术。在中度低温(肛温26～28℃)体外循环下行VSD及合并畸形修复,术后早期彻底镇静,给予压力控制(PC)机械通气模式,动脉血PaCO2维持25～35mmHg,拔除气管插管后加强体疗,防止肺部并发症及肺高压危象。结果早期(术后30d)死亡2例(3.5%)。早期并发症5例:2例残余漏,2/6级收缩期杂音,1年后自愈;右束支传导阻滞3例,无临床症状,未予处理。55例存活者随访2～60个月,体重及活动量均有增加,智力正常,心功能Ⅰ～Ⅱ级,无晚期并发症及晚期死亡。结论低体重婴儿VSD+PH特别是心衰难以控制者一经确诊应及时手术,效果满意。

Objective To review the experience of the surgical treatment of ventricular septal defect with pulmonary hypertension(VSD+PH)in low body-weight infants(<5kg).Methods From March,1998to March,200357infants with VSD+PH were subjected to operation treatment.All operations were performed under middle hypothermia(anus temperature26-28℃)extracorporeal circulation.Dardenolide,diuresis and dilatating blood vessel were given preoperatively.Emergency operation was performed for the infants whose heart failure can not be controlled within long times.All the patients were sedated completetly early postoperative and pressure control (PC)mode of ventilation were given.PaCO 2 were maintained25-35mmHg.Physical therapy was intensificated and pulmonary hypertension was prevented after extraction of indotracheal intubation.Results There were2patients dead within30days of posto-peration(mortality:3.5%);early complication:remains leak occurred in2patients and right bundle branch conduction block occurred in3cases.No late deathes and complication during follows up of2-60months,55surviving infants'heart function wereⅠ-Ⅱgrade.Conclusion Low body-weight Infants'VSD+PH ought to be operated early,thus the satisfactory effect just can be taken.