婴幼儿室间隔缺损合并肺动脉高压的外科治疗

Surgical Management of Ventricular Septal Defect With Pulmonary Hypertension in Infants

目的报道婴幼儿先天性室间隔缺损(VSD)伴肺动脉高压的手术修补结果及体会。方法1998年1月～2002年12月,对86例VSD伴肺高压的婴幼儿采用中深低温体外循环行手术治疗。术中术后加强心肌保护和呼吸道管理。结果治愈出院83例,死亡3例,死亡率为3.49%(3/86),均为肺高压临床4级病例。术后主要并发症为肺部感染、肺高压危象、低心排综合征。出院病人随访6月～5年,无死亡病例,心功能穴NYHA雪一级62例,二级18例,三级3例。结论婴幼儿VSD合并肺动脉高压者,应积极早期手术。围术期的心肌保护和呼吸道管理是手术成败的关键。

Objective To review the experience of surgical repair of ventricular septal defect (VSD) with pulmonary hypertension in infants. Methods Eighty-six infants with VSD underwent surgical repair from Jan 1998 to Dec 2002.All patients underwent surgical repair with moderate or deep hypothermia cardiopulmonary bypass (CPB). Results The hospital mortality rate was 3.49%(3/86). The causes of death were severe pulmonary hypertension. The main complications were pulmonary infection, pulmonary hypertensive crisis and low cardiac output syndrome. No dead case was ocurred in all the patients by followed-up for 6 months～5 years . Conclusions Surgical treatment of VSD with pulmonary hypertension in infants should be performed as earlier as possible. Perioperative management is an important factor influencing surgical outcome.