婴儿室间隔缺损修补术后早期处理_临床医学论文.docVIP

婴儿室间隔缺损修补术后早期处理_临床医学论文 婴儿室间隔缺损修补术后早期处理_临床医学论文 作者：罗瑞芳　陈景伟　钟焕清　夏天　赖锋华　林秋伟　刘浪　钟汝核　[摘要]目的 探讨婴儿室间隔缺损（VSD）修补术后早期防治各种并发症的措施。 方法 2006年6月至2008年6月，手术矫治婴儿VSD194例，男108例，女86例；年龄58 d~12个月，其中6个月以下者72例；体质量2.8~8.5 kg，其中3~5 kg 81例。超声心动图提示VSD直径5.0~16 mm，平均(9.1±3.4) mm。均在浅低温体外循环心脏停跳下行VSD修补手术。术后早期加强处理，防治肺部感染、肺动脉高压、心功能不全、心律失常等并发症。结果全组无死亡。术后早期房室传导阻滞5例，肺部感染17例，肺不张8例，经积极治疗后愈；无肺动脉高压危象或心力衰竭发生。全组随访2~24个月，无特殊严重并发症发生。结论 术后早期积极防治各种并发症是治疗婴儿VSD成功的重要保障。 　　[关键词] 先天性缺损；术后监护；婴儿 　　[Abstract] ObjectiveTo review the experience of early postoperative care in infants with ventricular septal defects.MethodsFrom June 2006 to June 2008, 194 infants with VSDs, whose age ranged from 58 days - 12 months and whose weight ranged from 2.8 to 8.5 kilograms, underwent surgical correction. The diameter of VSDs was 5.0 to 16 milimeters[mean (9.1±3.4) millimeters]. All infants were operated under mild hypothermic cardiopulmonary bypass and arresting heart. The complications of infection, arrhythmia, malnutrition, pulmonary hypertension or(and) heart failure were treated sufficiently in early postoperative stage.ResultsNo case died. Complications in early stage including 5 cases of arrhythmia, 17 cases of pulmonary infection and 8 cases of atelectasis were all cured. No pulmonary hypertension crises or heart failure occurred. No other severe complications occurred in following up 2 - 24 months.ConclusionEarly postoperative care makes great supportability for the success rate of VSD correction in infants. 　　[Key words]Heart defects congenital;Postoperative care; Infants 　　室间隔缺损（ventricular septal defect，VSD）是最常见的先天性心脏病，约占先天性心脏病的12%～20%。在婴儿期并有反复感染、发育不良、肺动脉高压和或心功能不全等情况的VSD患儿则需要手术治疗。同时，手术后早期也需要相应的积极处理，以防治可能出现的各种并发症。 2006年6月至2008年6月本院对194例婴儿VSD进行了外科治疗及积极的术后处理，临床效果满意。现报告如下。 　　1资料与方法 　　全组194例，男108例，女86例；年龄58 d~12个月，6个月以下者72例；体质量2.8~8.5 kg，平均（5.8±0.9）kg，其中3~5 kg 81例。根据病史、体征、X线胸片、心电图及超声心动图等明确诊断。术前心电图提示不完全性右束支传导阻滞22例；X线胸片提示肺血增多，心胸比率（C/T）为0.72±0.15；超声心动图提示VSD直径（短轴切面）5.0~16 mm，平均(9.1±3.4) mm，其中膜周型VSD105例，肺动脉瓣下型（干下型）VSD47例，嵴内型VS