1岁以内室间隔缺损并肺动脉高压病儿的外科治疗及围术期管理

目的 总结1岁以内室间隔缺损并肺动脉高压病儿的外科治疗和围术期处理的经验.方法 2006年11月-2009年8月,我科共手术治疗1岁以内室间隔缺损并肺动脉高压病儿41例.全组病例均在浅低温或低温体外循环下行畸形矫治术.结果 本组病儿无死亡.主要并发症有肺动脉高压危象、低心排血量综合征、肺不张、张力性气胸、出血、呼吸机相关性肺炎、血源性感染等.术后SaO2为93%～98%.随访6～24个月,病儿心功能较术前明显改善.结论 肺动脉高压危象和低心排血量综合征是先天性心脏病并肺动脉高压病儿术后的主要并发症.早期手术及良好的围术期处理是提高病儿生存率的关键.

SURGICAL MANAGEMENT OF INFANTS WITHIN 1 YEAR OLD WITH VENTRICULAR SEPTAL DEFECT WITH PULMONARY HYPERTENSION

Objective To summarize the experiences of surgical management of ventricular septal defect in infants within 1 year old with pulmonary hypertension. Methods From November, 2006 to August, 2009, 41 infants within 1 year old with ventricular septa[ defect and pulmonary hypertension underwent open heart surgery in our hospital. Results There were none operative deaths, The major postoperative eompllcations ineluded pulmonary hypertension crisis, low cardiac output, pulmonary atelectasis, tension pneumothorax, bleed, ventilator related pneumonia, respiration failure, infection. Postoperative SaO2 ranged from 93% to 98%. 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 of congenital heart disease in infants with pulmonary hypertension. Early surgical operation and goocl perioperative treatment are the key to elevate the survival rate of the operation.