重症婴儿室间隔缺损外科治疗的体会

Surgical treatment of severe ventricular septal defect in infants

目的 :总结重症婴儿室间隔缺损 (VSD)的外科治疗经验。方法 :全组 6 1例 ,术前均有反复感染、缺氧发作、营养不良、肺动脉高压和 (或 )心功能不全等的情况。做好抗感染、氧疗、降肺压、抗心力衰竭、营养支持等充分术前准备后行心内直视手术 ,均用补片修补室缺。结果 :全组死亡 2例 ,生存 5 9例中低心排综合征 3例 ,肺动脉高压危象 4例 ,严重肺部感染 6例 ,血气胸及痰堵导致肺叶不张各 2例 ,拔管后窒息再插管 2例 ,严重心律失常 2例 ,VSD残余分流 1例。结论 :婴儿室间隔缺损伴有反复感染、缺氧发作、营养不良、肺动脉高压和 (或 )心功能不全等宜及早手术治疗 ,提高手术技巧和加强围术期处理是治疗成功的关键。

Objective:To summarize the experience of surgical repair of severe ventricular septal defect (VSD)in infants.Methods:Sixty-one infants with VSD had one or more complications such as repetitive infection,anoxia,malnutrition,pulmonary hypertension,heart failure and so on.The ventricular defects were repaired with patches after adequately preoperative management.Results:Only two patients died.The postoperative complications of the survivals were as follows:low cardiac output syndrome in 3,pulmonary hypertension crisis in 4,severe pulmonary infection in 6,pneumohemothorax in 2,atelectassis in 2,secondary intubation in 2,severe arrhythmia in 2,and VSD residual flow in 1 case.Conclusion:Surgical intervention should be performed for the infants with severe VSD as soon as possible.The successful results depend on the improvement of surgical skills and perioperative management.