婴幼儿室间隔缺损合并动脉导管未闭的诊治体会
[作者简介] 杨学勇(1970.4-),男,副主任医师,研究方向为复杂先天性心脏病的诊断和治疗。
[摘要] 目的:总结婴幼儿室间隔缺损合并动脉导管未闭的外科诊治经验。方法:回顾性分析36例室间隔缺损合并动脉导管未闭婴幼儿的临床特征、手术过程、围术期处理与转归。术前支气管肺炎并发心力衰竭需要气管插管呼吸机辅助呼吸2例,需要鼻塞持续气道正压通气(CPAP)辅助呼吸4例。动脉导管未闭手术方式为结扎34例,从肺动脉腔内缝闭2例(术前漏诊)。结果:无住院死亡病例。ICU停留时间3~20 d,平均5 d。术后住院时间为8~25 d,平均10 d。并发症为灌注肺1例,肺不张6例,气胸3例,肺出血1例。术后3个月复查,发现室间隔缺损残余漏1例。结论:室间隔缺损合并动脉导管未闭临床上易与单纯室间隔缺损相混淆,术前容易漏诊而导致灌注肺,应加强术前诊断及术中探查。术前支气管肺炎并发心力衰竭需要呼吸机支持,不是手术禁忌证,只要加强围术期管理,仍可取得良好疗效。手术均可以正中切口一期完成,并行循环下游离结扎动脉导管操作简单、安全、可靠,明显优于经肺动脉腔内缝合。
[关键词] 室间隔缺损;动脉导管未闭;肺动脉高压;诊断;外科手术
[中图分类号] R725.4[文献标识码]B[文章编号]1673-7210(2011)07(c)-152-03
Diagnosis experience on surgical treatment of infants with ventricular septal defect and patent ductus arteriosus
YANG Xueyong1, ZHOU Gengxu1, Hong Xiaoyang2, FU Song1, LIU Yuhang1, WANG Hui1, FENG Zhichun2*
1.Cardiac Surgery Department, Bayi Children"s Hospital Affiliated of General Hospital of Beijing Military Region, Beijing 100700, China; 2.Intensive Care Unit, Bayi Children"s Hospital Affiliated of General Hospital of Beijing Military Region, Beijing 100700, China
[Abstract] Objective: To summarize the experience of diagnosis and surgical treatment of infants with ventricular septal defect (VSD) with patent ductus arteriosus (PDA). Methods: The authors retrospectively analyzed the clinical data of 36 cases of VSD with PDA who underwent surgical treatment. 6 cases suffering from pneumoni...
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