婴儿先天性心脏病合并肺动脉高压的外科治疗

目的:总结婴儿先天性心脏病合并肺动脉高压的外科治疗和围术期处理的经验。方法:2004年1月～2006年6月共手术治疗婴儿先天性心脏病合并肺动脉高压患者72例,男性45例,女性27例;年龄2个月～1岁,平均(7.3±2.8)月,体重3.5～9.2kg,平均(6.2±3.6)kg。术前肺动脉收缩压为47.4～89.2mmHg,平均(64.3±7.6)mmHg;动脉血氧饱和度81%～98%。结果:手术死亡3例(4.17%)。主要并发症有肺动脉高压危象、低心输出量综合症、肺不张、张力性气胸、呼吸机相关肺炎、血源性感染,呼吸衰竭等。死亡原因:肺动脉高压危象2例,低心输出量综合症1例。术后SaO287%～98%。随访6个月～2年,无晚期死亡,余患者心功能较术前改善。结论:肺动脉高压危象和低心输出量综合症是婴儿先天性心脏病合并肺动脉高压患者术后的主要并发症和死亡原因,早期手术及搞好围术期的处理是提高生存率的关键。

Surgical management of infants with congenital heart disease complicated with pulmonary hypertension

Objective:To summarize the experiences of surgical management of congenital heart disease in infants with pulmonary hypertension.Methods:From Januaryl,2004 to June,2006,72 infants with congenital heart disease and pulmonary hypertension underwent open heart surgery in our hospital,including 45 males and 27 females.They were 2 to 12 months old and 3.5 to 9.2 kg weight.Their pulmonary systolic pressure ranged from 47.4 to 89.2 mmHg and arterial oxygen saturation from 81% to 98% before surgery therapy.Results:There were 3 operative deaths(2 died of pulmonary hypertension crisis and 1 of low cardiac output)and the operative mortality was 4.17%.The major postoperative complications included pulmonary hypertension crisis,low cardiac output,pulmonary atelectasis,tension pneumothorax,ventilator related pneumonia,respiration failure,infection.Postoperative SaO2 ranged from 87% to 98%.No late death occurred during the follow-up period(6 to 24 months).The heart function of the survivals was better than that before the operation.Conclusion:Low cardiac output and pulmonary hypertension crisis are two postoperative complications and death causes of congenital heart disease in infants with pulmonary hypertension.Early surgical operation and good perioperative treatment are the key to elevate the survival rate of the operation.