低龄低体重婴幼儿先天性室间隔缺损并肺动脉高压的外科治疗  

Surgical treatment of ventricular septal defect with severe pulmonary hypertension in younger infants with low weight

作　　者：杨旭[1] 马润伟[1] 宋怡[1] 李劲松[1] 王东坤[1] 张晓羽[1] 赵子梁[1] 

机构地区：[1]云南省第二人民医院心血管外科,云南昆明650021

出　　处：《云南医药》2015年第4期391-393,共3页Medicine and Pharmacy of Yunnan

摘　　要：目的通过对我科2001年12月-2014年12月手术治疗低龄（小于1.5岁）低体重（小于10kg）125例婴幼儿先天性室间隔缺损并肺动脉高压外科手术矫治进行总结、归纳,探讨低龄低体重婴幼儿先天性室间隔缺损并肺动脉高压外科手术适应症的选择,手术方法和围手术期处理。方法本组125例婴幼儿,男72例,女53例,年龄3月-1.4岁,体重2.8kg-10kg,安静状态下经皮血氧饱和度94%~97%,术前彩超示患儿肺动脉收缩压均大于50mm Hg,术前胸片均示肺血增多,肺动脉段突出,但无残根样改变,心胸比率0.5-0.74。心电图示左、右室扩大肥厚,T波高耸。结果本组125例患儿死亡1例,其余124例均顺利出院。随访时间3-72月,患儿发育正常,活动能力基本正常,心功能（1-2）级,术后3月复查彩超示肺动脉压力已明显下降,接近正常,本组患儿均无晚期死亡。结论低龄低体重先天性室间隔缺损并肺动脉高压婴幼儿排外手术禁忌症均应考虑手术治疗,外科手术矫治效果良好、确切,是控制心衰和防止肺动脉压力进一步升高的安全有效的治疗方法。掌握手术指征、手术技巧及围术期处理能提高手术生存率。Objective To evaluate the choice of surgical indications,surgical procedure and treatment in preoperative period of younger infants with low weight who had ventricular septal defect with severe pulmonary hypertension. 125 younger infants（less than 1.5 years old） with low weight（less than 10 kg） who had ventricular septal defect repair were studied between December 2001 and December 2014. Methods 125 younger infants（72males,53females）, ages ranged from 3months to 16 months, body weight ranged from 2.8kg to 10 kg, and blood oxygen saturation ranged from 94% ~97% at rest were analysed. Echocardiography preoperative showed that SPAP 〉50mm Hg, chest PA showed that there were more pulmonary blood volume, bulging pulmonary artery segment, while,there were no root-like changes, cardio-thoracic ratio ranged from0.5~0.74. The electrocardiograms displayed hypertrophy and dilation of left atrium and ventricular, increased T wave. Results All these 125 patients were successfully discharged from hospital except one, there were no late death. The follow-up time ranged from（3~72）months, and these patients developed normally, got regular activities, with NYHA classⅠ~Ⅱ.The SPAP of these patients decreased distinctly. Conclusion Younger infants with low weight who had ventricular septal defect with severe pulmonary hypertension should get surgical treatment. The surgical treatment has good and effective results, it’s the safe effective treatments to control heart failure and SPAP. So grasping the surgical skills, and operation indication is necessary.

关 键 词：先天性室间隔缺损 肺动脉高压 外科治疗 

分 类 号：R654.2[医药卫生—外科学]