摘要
目的探讨婴儿大型室间隔缺损（VSD）合并肺炎早期手术治疗的手术时机、适应证以及围术期处理。方法选择2010年1月-2012年7月本院收治的大型VSD合并肺炎患儿36例。男16例,女20例;年龄1-12（7.1±3.2）个月;体质量3.5-10（6.2±2.2）kg。合并畸形中卵圆孔未闭15例、房间隔缺损6例、动脉导管未闭5例、永存左上腔静脉5例。患儿均在低温、体外循环下行VSD直视修补术及合并畸形矫治术,其中11例经右侧腋下垂直小切口施术,25例经前正中切口施术。36例患儿VSD修补均采用涤纶补片修补,术中均应用小儿膜式氧合器和术中平衡或改良超滤。结果 36例患儿手术均获成功,术后主要并发症为肺部感染6例;切口愈合不良3例,无难以控制的全身严重感染、肺动脉高压危象及严重低心排综合征,36例患儿均痊愈出院。随访2-26个月,上呼吸道感染显著减少,营养发育状况明显改善。结论重视围术期治疗,把握手术时机和适应证,果断早期进行外科手术治疗,对治疗大型VSD并肺炎的婴儿是安全、有效的方法。
【Objective】To explore the operating opportunity, indication, perioperation management of early repair in infants with large ventricular septal defect（VSD） complicated with pneumonia.【Methods】From Jan. 2010 to Jul.2012, 36 infants [16 male and 20 female, aged 1-12（7.1±3.2） months, weighted 3.5-12（6.2±2.2） kg] with large VSD complicated with pneumonia were admitted to our hospital. Fifteen cases were associated with patent foramen ovale,6 cases were associated with atrial septal defects, 5 cases were associated with patent ductus arteriosus, 5 cases were associated with persistent left superior vena cava; thirty cases were membrane type, 6 cases were subpulmonary valve type. All patients underwent cardiopulmonary bypass with systemic hypothermia and cold crystle cardioplegia. Total surgical correction was done to repair all anomaly. Dacron patches were used in 36 cases. Membrane oxygenator and ultrafiltration were used in all cases. 【Results】All patients underwent successful surgery. Main complications of postoperation were pneumonia（6 cases）, bad coalesce of incision（3 cases）. There was no severe infection, pulmonary hypertention crisis and severe low cardiac output. All patients had been cured. Followed-up for 2-26 months, all patients had good results. 【Conclusions】Intensively treating perioperation, choosing good opportunity and perform operation at early stage are safe and effective ways for children who suffer large VSD complicated with pneumonia.
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2014年第30期92-94,共3页
China Journal of Modern Medicine
关键词
室间隔缺损
肺炎
外科手术
婴儿
ventricular septal defect pneumonia surgical operation infant
