体重6kg以下婴儿室间隔缺损的外科治疗  

Surgical Treatment for Infants Under 6 kg Weight with Ventricular Septal Defect

作　　者：吴忠仕[1] 胡建国[1] 尹邦良[1] 杨一峰[1] 周新民[1] 刘锋[1] 罗会昭[1] 

机构地区：[1]中南大学湘雅二医院胸心外科,长沙410011

出　　处：《中国胸心血管外科临床杂志》2005年第5期320-322,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨低体重婴儿室间隔缺损(VSD)的外科治疗适应证、手术技术及围术期处理.方法 148例体重6kg以下(体重3.5～6.0kg,平均5.3 kg)VSD患者中,VSD位于膜周部105例,动脉瓣下25例,肌部流出道9例,肌部流入道8例,肌小梁部1例.其中合并房间隔缺损(ASD)或者卵圆孔未闭39例,动脉导管未闭(PDA)17例,二尖瓣关闭不全(MI)9例,中度以上肺动脉高压(PH)52例.148例患者均在中度低温、中低流量体外循环下行VSD修补术和合并畸形矫治,VSD补片修补85例,直接缝合63例;其中施行小切口心脏不停跳手术23例.结果手术死亡6例,手术死亡率为4.1%(6/148),其中2例合并重度肺动脉高压,1例术前严重营养不良术后全身衰竭死亡,2例术中发现合并主动脉弓中断,1例合并二尖瓣反流行二尖瓣成形效果不佳.2例VSD残余分流(1～2mm);2例Ⅲ°房室传导阻滞应用临时心表起搏器起搏,均在术后5 d内恢复窦性心律.术后住院时间6～15d(平均8d).随访142例,随访时间4个月～6年,2例残余分流(2mm),1年后杂音消失,心脏超声心动图示VSD已愈合,无分流;心功能Ⅰ～Ⅲ级,生长发育良好.结论随着外科技术提高及设备的更新,低体重婴儿VSD的手术治疗安全、效果良好;对合并复杂畸形的婴儿患者手术疗效仍有待进一步提高.Objective To investigate the effect of surgical treatment on ventricular septal defect （VSD） in infants under 6kg weight, including the operative indication, surgical techniques and perioperative therapy. Methods All clinical data of 148 consecutive infants under 6kg weight with VSD were collected and studied retrospectively. The infants, age was 1-13（mean 5.3） months with the body weight of 3.5-6.0 （mean 5.3） kg. VSD was perimembranous in 105 cases, subpulmonary in 25, muscular inlet tract in 8, muscular outlet tract 9, and muscular trabecular in 1 case. Other associated cardiac abnormalities included atrial septal defect in 39, patent ducts arteriosus in 17, insufficiency of mitral valve in 9 and moderate to severe pulmonary hypertension in 52. The operations were performed under cardiopulmonary bypass at moderate to low flow, moderate hypothermia and cold crystalloid cardioplegia. Patch repair was used in 85, direct sutures in 63 and 23 cases repaired with partial sternal incision and beating heart. Results The hospital mortality was 4. 1% （6/148）, the causes of death were severe pulmonary hypertention in 2, aortic arch interruption in 2, severe malnutrition in 1 and poor result of mitral valvuloplasty in 1. Other major operative complications included residual shunts （1- 2mm） in 2, and Ⅲ° A-V block in 2, who recoveried 5 days after the operation. The hospital stay was 6 15 （mean 8） days. Follow-up was complete in all 142 survived cases for 4 months-6 years. Two residual shunts healed in first year after the cardiac operation, others recovery smoothly, and are developing well. Conclusion With the improvement of the surgical techniques, the surgical treatment for VSD in infants with low weight is safe and effective, and it is also essential to further improve the effects of surgical treatment in VSD associated with complex abnormalities.

关 键 词：婴儿 先天性心脏病 室间隔缺损 外科治疗 

分 类 号：R726.5[医药卫生—儿科]