儿童单纯大型室间隔缺损开胸手术年龄选择与风险  

Choice of surgical age and risk of thoracic surgery in children with simple and large ventricular septal defect

作　　者：邓勇丽[1] 韦丹[1] DENG Yongli;WEI Dan(Pediatric Intensive Care Unit,First Affiliated Hospital of Guangxi Medical University,Nanning 530021,China)

机构地区：[1]广西医科大学第一附属医院PICU,南宁530021

出　　处：《山西医科大学学报》2018年第9期1108-1111,共4页Journal of Shanxi Medical University

摘　　要：目的探讨儿童单纯大型室间隔缺损开胸手术年龄选择与风险。方法回顾性分析我院2016-06~2017-05收治的184例单纯大型室间隔缺损体外循环下开胸修补术患儿的临床资料,按手术年龄分为三组(婴儿组36例、幼儿组34例、年长儿组114例),比较三组患儿的临床特征、术后并发症及预后。结果三组患者在性别构成、诊断年龄、室间隔缺损大小及死亡率方面差异无统计学意义(P<0.05);手术年龄越小,术前反复肺炎、肺动脉高压、心力衰竭、术后并发症发生率越高(P<0.05),术后住院时间、术后机械通气时间及术后住ICU时间越长(均P<0.05)。婴儿组营养不良发生率、术前ICU住院率较幼儿组及年长儿组高,术前住院时间及体外循环时间、主动脉阻断时间较幼儿组及年长儿组长(均P<0.05)。结论(1)低年龄、肺动脉高压、心力衰竭并非手术绝对禁忌,对伴有危重症表现的室间隔缺损患儿,选择急诊或亚急诊手术矫治心脏畸形是有必要的。(2)低年龄手术不增加患儿手术及术后死亡风险,当面临急诊或亚急诊手术,术后并发症重,可考虑选择在发生严重并发症前开胸手术修补。Objective To explore the choice of surgical age and risk of thoracic surgery in children with simple and large ventricular septal defect.Methods One hundred and eighty-four patients with thoracotomy under cardiopulmonary bypass from June 2016 to May 2017 were analyzed retrospectively, and were divided into three groups according to the age of operation： 0-1 year old group（ n =36）, 1-3 years old group（ n =34）, 3-15 years old group（ n =114）. The clinical characteristics, postoperative complications and prognosis were compared between three groups.Results There was no significance in gender, age of diagnosis, ventricular septal defect and mortality among the three groups（ P 〉0.05）. The younger the operative age was, the higher incidences of preoperative pneumonia, pulmonary hypertension, heart failure, postoperative complications were（ P 〈0.05）, the longer the postoperative hospital stay, the time of PICU and the time of mechanical ventilation were （ P 〈0.05）. In addition, the incidence of malnutrition in 0-1 year old group was higher than that in 1-3 years old group and 3-15 years old group, and the preoperative hospital stay and the time of cardiopulmonary bypass were longer than those of the other groups（ P 〈0.05）.Conclusion ①Low age, pulmonary hypertension, heart failure were not absolute contraindications to surgery. It is necessary to choose an emergency or subacute surgery to correct cardiac malformations for patients with severe manifestations of ventricular septal defect. ②Low age does not increase the risk of surgery and postoperative death, but when an emergency or subacute surgery is inevitable and the complications are serious, it may be considered to operate thoracic surgery repair before the serious complications.

关 键 词：室间隔缺损 体外循环手术 围手术期 并发症 儿童 

分 类 号：R726.1[医药卫生—儿科]