婴幼儿室间隔缺损合并动脉导管未闭诊治体会.docVIP

婴幼儿室间隔缺损合并动脉导管未闭诊治体会[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 pneumonia and heart failure needed intensive respiratory support. Among the 6 cases, 2 cases were with invasive mechanical ventilation while 4 cases were with nose-stuffy CPAP. 34 patients were ligated and 2 patients were sutured from pulmonary cavity (the diagnosis of the 2 PDAs was missed during the preoperative ultrasound). Results: There was no hospital mortality. ICU stay was 3-20 days (mean 5 days). Hospital stay after the operations was 8-25 days (mean 10 days). The perioperative complications included perfused lung (1 case), pulmonary atelectasis (6 cases), pneumothorax (3 cases), an