婴幼儿室间隔缺损伴肺动脉高压围术期处理

目的：介绍婴幼儿室间隔缺损(VSD)伴肺动脉高压(PH)围术期处理经验。方法：自1996年1月-2003年8月,47例SVD伴PH婴幼儿应用浅低温体外循环、温血心肌停搏液连续灌注及间断褥式缝合法进行VSD修补术。围术期进行综合性降肺动脉压的处理,注意心肌保护,合理使用呼吸机及供氧,保持呼吸道通畅,正确应用强心剂、利尿剂、镇静剂及广谱抗生素。结果：2例(4．3％)患儿术后分别死于呼吸功能衰竭及肺动脉高压危象,2例(4．3％)患儿术后分别并发右心功能不全及低心排血量综合征,治愈出院。随访36例,恢复良好。结论：VSD伴PH婴幼儿围术期注意维护心肺功能,合理应用肺血管扩张药物,手术安全性提高、死亡率降低。

Perioperative Management of Ventricular Septal Defect with Pulmonary Hypertension in Infants

Objective This paper reviewed the experience of perioperative management of ventricular septal defect(VSD)with pulmonary hypertension(PH)in infants.Methods 47 patients with VSD+PH underwent surgical repair under cardiopulmonary bypass from Jan.1996 to Aug.2003.The perioperative treatment of reducing PH,preserving myocardium and keeping respiratory track unobstructed was undergone properly.Heart stimulant,diuress,sedative,analgesic and antibiotic were taken rationally.Results Postoperative complications included respiratory failure,PH crisis,cardiac insufficiency and low cardiac output sydrome.2cases(4.3%)died of respiratory failure and PH crisis respectively.36 cases were followed-up and they recovered well.Conclusion Proper perioperative management of cardiac function,respiratory function and PH is emphasized on large VSD+PH in infants,which can reduce the operative mortality and morbidity.