婴儿室间隔缺损伴重度肺动脉高压的外科治疗

目的:探讨如何降低婴儿室间隔缺损伴重度肺动脉高压外科治疗的病死率?严重并发症发生率?方法:1998年1月～2003年12月手术治疗108例婴儿室间隔缺损伴重度肺动脉高压,其中53例患儿为前组(1998年1月至2001年12月),55例患儿为后组(2002年1月至2003年12月)?前组预充液中加白蛋白20 g/L,未采用改良超滤,心肌保护用Thomas晶体停搏液;后组预充液中白蛋白用量增至50 g/L,并加用抑肽酶,术终全部采用改良超滤,心肌保护用4:1冷血停搏液?比较前后两组的病死率?严重并发症发生率?呼吸机使用时间?ICU滞留天数的变化?结果:后组的病死率?低心排发生率?呼吸机使用时间?ICU滞留天数分别比前组下降了84.1%(P<0.01)?85.3%(P<0.05)?59.0%(P<0.05)?55.2%(P<0.05)?结论:婴儿大型室间隔缺损,采取综合治疗措施,可降低各种并发症,降低病死率?

Surgical operation of ventricular septal defect with severe pulmonary hypertension in infants

Objective: To explore the effect of combined methods on decreasing the mortality and complications of infants with ventricular septal defects and severe pulmonary hypertension. Methods: From January 1998 to December 2003, 108 cases of ventricular septal defects with severe pulmonary hypertension were operated. The first group included 53 patients from January 1998 to December 2001 and the second group included 55 patients from January 2001 to December 2003. We added albumin(20g/L) into the prime before cardiopulmonary bypass, used St. Thomas solution in heart protection, and did not use modified ultrafiltration in the first group. We added more albumin(50g/L) into the prime before cardiopulmonary bypass, used aprotinin and modified ultrafiltration in the end of the operation, and then used 4:1 cold (V:V) blood cardioplegia solution in heart protection in the second group. The mortality, incidence of critical complications, ventilator supporting time and cardiac intensive care unit (CICU) staying of the two groups were compared. Results: The mortality, incidence of low cardiac output, ventilator supporting time and CICU staying in the second group were decreased by 84.1%(P<0.01), 85.3%(P<0.05), 59.0%(P<0.05) and 55.2%(P<0.05) than those in the first group. Conclusion: The combined therapy decreases the mortality and complications of infants with big ventricular septal defects and severe pulmonary hypertension. [