摘要
目的:研究婴幼儿室间隔缺损(VSD)围术期一般情况、术后并发症发生率及外科手术疗效。方法:回顾性分析2010年1月至2015年6月期间,我院手术治疗婴幼儿无合并复杂心内畸形的VSD 537例。婴儿(3~12个月)109例,体质量(5.7±2.4)kg。幼儿(13~36个月)428例,体质量(11±5.9)kg。患儿均于体外循环下行VSD修补术及同期合并简单畸形矫治术。结果:巨大VSD比率,反复心力衰竭、肺炎、生长发育迟缓发生率及合并肺动脉高压率在婴儿组与幼儿组分别为75%vs.29%,69%vs.22%,78%vs.24%,组间比较差异有统计学意义(P=0.00,P=0.00,P=0.00)。两组患儿术后呼吸机辅助时间及术前、术后住院时间分别为(32.7±17.4)vs.(16.8±15.3)h,(7.6±5.5)vs.(5.2±3.7)d,(10.9±6.5)vs.(6.9±2.8)d,组间差别显著,差异有统计学意义(P=0.00,P=0.00,P=0.00)。术后两组患儿并发肺炎、肺不张,肺动脉高压危象,渗漏综合征,急性肾功能损伤,低心排出量综合征发生率分别为10%vs.4.7%,4.6%vs.0.7%,5.5%vs.0.7%,5.5%vs.1.2%,7.3%vs.2.3%,婴儿组发生率高,组间差异有统计学意义(P=0.03,P=0.01,P=0.00,P=0,00),(P=0,01)。537例患儿术后随访1~5年,生长发育良好,超声心动图示射血分数正常,肺动脉压力正常。结论:外科手术治疗的婴幼儿月龄越小术前一般情况越差,巨大VSD比率及术后并发症发生率越高;但通过合理的手术方案、体外循环及围术期处理,婴幼儿均能获得满意的手术疗效。
Objective：To study the perioperative general condition, postoperative complication inci- dence and surgical treatment efficacy in infants with ventricular septal defect （VSD）. Methods： We retrospec- tively analyzed 537 cases of infants with VSD not combined complex cardiac malformation from January 2010 to June 2015, who were under surgical treatment in our department. There were 109 cases of baby （ 3 to 12 months ）, body weight （ 5.7 ± 2.4 ） kg. Early childhood （ 13 - 36 months） 428 cases, body weight （ 11 ±5.9 ） kg. VSD were repaired under extracorporeal circulatory arrest and combined simple malformation were repaired in the same period. Results： The ratio of large VSD, repeated pneumonia and growth retardation and heart fail- ure and pulmonary hypertension in baby group and early childhood group were 75% vs. 29% ,69% vs. 22%, 78% vs. 24% respectively. There were significant differences between the two groups, P =0.00, P =0.00, P = 0.00. The time of postoperative respiratory support, preoperative and postoperative hospitalization in two groups were（32. 7± 17.4）vs. （16. 8 ±15.3）h, （7.6 ±5.5）vs. （5.2 ±3.7）d, （ 10. 9 ± 6. 5）vs. （6. 9 ± 2. 8）d respectively. There was statistically significant differences between the two groups, P = 0. 00, P = 0. 00 and P = 0. 00. The incidence of pneumonia ＆ atelectasis, pulmonary arterial hypertension crisis, leakage syndrome, acute renal injury, low cardiac output in two group after operation was 10% vs. 4. 7% ,4. 6% vs. O. 7% ,5.5% vs. O. 7% ,5.5% vs. 1.2% ,7.3% vs. 2. 3% respectively. The incidence were higher in baby group, which were statistically significant difference between two groups, P = 0. 03, P = 0. 01, P = O. 00, P = 0. 00, P = 0. 01. Followed up for 1 -5y, the development of all 537 cases were well. Ultrasonic cardiogram showed normal ejection fraction of left ventricular and normal pulmonary artery pressure. Conclusion：The younger had in- fants received surgical operation, the worse was preoperative general conditions, and the higher was the ratio of large VSD and the incidence rate of postoperative complications. But through reasonable operative procedure, extracorporeal circulation and perioperative treatment, infants could be satisfied with the outcome of surgical op- eration.
出处
《心肺血管病杂志》
2017年第5期377-381,共5页
Journal of Cardiovascular and Pulmonary Diseases
关键词
室间隔缺损
婴幼儿
先天性心脏病
回顾性研究
Ventricular septal defect
Infants
Congenital heart disease
Retrospective study
