5 kg以下低体重婴儿室间隔缺损的外科治疗

目的:探讨5 kg以下低体重婴儿室间隔缺损(VSD)的外科治疗适应证、手术时机、手术技术及围术期处理。方法:回顾性分析2001年1月至2005年12月期间,5kg以下VSD婴儿134例,年龄(3.9±1.9)月。患儿均于体外循环下行室间隔缺损修补术及同期合并畸形矫治术。结果:全组术后早期死亡1例,死亡率0.7%,死亡原因心律失常,心功能衰竭。术后并发肺炎14例,肺高压危象6例,肺不张4例,心律失常4例,低心排4例,胸腔积液1例。133例随访6个月~6年,生长发育良好;VSD残余分流2例,1年后超声心动图证实已自动愈合。结论:低体重婴儿VSD的外科治疗效果良好,正确选择手术适应证和时机、正确合理的体外循环和手术方法、加强围术期处理是提高治疗效果的关键。

Surgical treatment for ventricular septal defect in infants under 5 kg of body weight

OBJECTIVE: To review the indication and timing of surgery,surgical techniques and perioperative management of ventricular septal defect (VSD) repair on infants under 5 kg of body weight. METHODS: From January, 2000 to December, 2005, 134 children patients with VSD and associated anomalies, who were under 5 kg of body weight and aged (3.9+/-1.9) months, were diagnosed and treated in our department. RESULTS: One case died of arrhythmia and heart failure in the early stage of postoperation (mortality 0.7%). The most common postoperative complications were pneumonia (14), pulmonary hypertensive crisis (6), arrhythmia (4), low cardiac output (4), dropsy of thoracic cavity(1). Followed up for 6 m-6 y, the development of all 133 cases was well. Two children with residual shunt got a spontaneous closure confirmed by echocardiography one year postoperatively. CONCLUSION: The clinical results of operations on VSD infants with low body weight are satisfactory with attention to the indication and timing of surgery, proper CPB management, rational operations and perioperative management.