大型室间隔缺损并肺炎婴幼儿的外科治疗

目的 探讨大型室间隔缺损(VSD)并肺炎婴幼儿早期手术治疗的可行性、手术时机、适应证以及术中术后的处理.方法　选择2009年10月-2010年7月本院收治的大型VSD并肺炎患儿19例.男11例,女8例;年龄3～15(7.3±2.8)个月;体质量5～12(7.6±1.4) kg .其中VSD并房间隔缺损5例、并动脉导管未闭1例;膜周部VSD 16例,肺动脉瓣下VSD 3例.患儿均在低温、体外循环、冷晶体停跳液灌注下行VSD直视修补术及并发畸形矫治.16例膜周部VSD患儿均经右房切口修补;3例肺动脉瓣下VSD患儿中,2例经肺动脉横切口修补,1例经右室流出道切口修补.19例患儿VSD修补均采用补片修补法,其中15例应用牛心包补片,4例应用自体心包补片(戊二醛固定).患儿术中均应用膜式氧合器和术中平衡超滤.结果　19例患儿手术均获成功,术后主要并发症为肺部感染3例,切口愈合不良2例,肺不张和室间隔少量残余分流各1例,无全身感染、肺动脉高压危象以及严重低心排病例,19例患儿均治愈出院.门诊随访2～6个月,上呼吸道感染显著减少,营养发育状况改善.结论　把握手术时机和适应证,早期手术、防治术中和术后肺损伤,是治疗大型VSD 并肺炎婴幼儿的有效方法.

Surgical Treatment of Large Ventricular Septal Defect Complicated with Pneumonia in Infants

Objective To investigate the feasibility,operation time,indication,management during and after operation of early repair in infants with large ventricular septal defect(VSD) complicated with pneumonia.Methods From Oct.2009 to Jul.2010,19 infants[11 male and 8 female,aged 3-15(7.3±2.8)months,weighted 5-12(7.6 ±1.4) kg] with large VSD complicated with pneumonia were admitted to the Second Hospital of Hebei Medical University.Five cases were associated with atrial septal defects,1 case was associated with patent ductus arteriosus;16 cases were membrana type,3 cases were subpulmonary valve type.All patients underwent cardiopulmonary bypass with systemic hypothermia and cold crystle cardioplegia.Total surgical correction was done to repair all anomaly.Pericardial patches were used in 19 cases.Membrana oxygenator and ultrafiltration were used in all cases.Results All patients underwent successful surgery.Main complications of postoperation were pneumonia(3 cases),bad coalesce of incision(2 cases),atelectasis(1 case)and minimal residual shunt of VSD(1 case).There was no severe infection,pulmonary hypertention and severe low cardiac output.All patients had been cured.Followed-up for 2-6 months,all patients had good results.Conclusions Avoiding pulmonary damage during and post operation,choosing good opportunity and perform operation at early stage are effective ways for children who suffer large VSD complicated with pneumonia.