102例室间隔缺损合并动脉导管未闭的诊治体会

目的：总结室间隔缺损合并动脉导管未闭的诊断和外科手术治疗体会。方法：回顾性分析102例室间隔缺损合并动脉导管未闭患者(95例合并不同程度肺动脉高压)手术治疗的临床资料。其中术前心脏彩超诊断为室间隔缺损合并动脉导管未闭者82例，室间隔缺损20例。结果：住院期间死亡率4.9%(5/102)。死亡原因分别为：低心排出量综合征1例，肺高压危象2例，呼吸衰竭2例。其余患者并发肺部感染7例，肺不张5例，胸腔积液1例，肺高压危象2例。所有存活患者肺动脉高压均有不同程度下降，效果满意。结论：室间隔缺损合并动脉导管未闭临床上易与单纯室间隔缺损相混淆，术前容易漏诊因而导致术中发生灌注肺。因此，应加强术前诊断及术中探查，以避免灌注肺的产生。同时室间隔缺损合并动脉导管未闭者肺动脉高压出现早、进展快，易发展成器质性肺动脉高压，影响手术的远期疗效，甚至丧失手术机会。所以一经诊断，应尽早手术，选择恰当的手术时机，加强围手术期管理，一般均可取得良好疗效。

Diagnosis and surgical treatment of 102 cases of ventricular septal defect with patent ductus arteriosus

Objective To summarize the experience of diagnosis and surgical treatment of ventricular septal defect with patent ductus arteriosus. Methods We retrospectively analyzed the clinical data of 102 cases of ventricular septal defect combined with patent ductus arteriosus who underwent surgical treatment.Preoperative ultrasonic cardiogram (UCG) showed ventricular septal defect combined with patent ductus arteriosus in 82 cases and ventricular septal defect in 20 cases. Results The hospital mortality was 4.9%(5/102). The reasons for death included low cardiac output syndrome (1 case),pulmonary hypertension crisis (2 cases) and respiratory failure (2 cases). In the remaining patients,the perioperative complications included lung infection (7 cases), pulmonary atelectasis (5 cases), hydrothorax (1 case), and pulmonary hypertension crisis (2 cases); and all the 15 patients recovered lastly.The pulmonary hypertension of all living patients decreased to some degree.The therapeutical effectiveness was satisfactory. Conclusion Ventricular septal defect with patent ductus arteriosus is easy to be confused with ventricular septal defect clinically. At the same time,it is diffcult to form a correct diagnosis in some patients by UCG preoperatively. To prevent the occurrence of perfusive lung,it is important to reinforce preoperative diagnosis and exploration during operation.Because pulmonary hypertension in patients with ventricular septal defect with patent ductus arteriosus emerges early and develops quickly, it tends to result in organic pulmonary hypertension which can make patients lose operation chances and influence the long-term therapeutical effect. Surgical operation should be performed as soon as possible.Optimal operative timing and proper perioperative management play important roles in surgical results.