南昌大学学报（医学版）
南昌大學學報（醫學版）
남창대학학보（의학판）
ACTA ACADEMIAE MEDICINAE JIANGXI
2014年
2期
35-37
,共3页
Down综合征%室间隔缺损%手术治疗%婴幼儿
Down綜閤徵%室間隔缺損%手術治療%嬰幼兒
Down종합정%실간격결손%수술치료%영유인
Down syndrome%ventricular septal defect%surgical treatment%children
目的：总结 Down 综合征患儿室间隔缺损的外科治疗经验。方法48例 Down 综合征患儿室间隔缺损在全身麻醉低温体外循环下行一期根治术。术前对于合并肺部感染、心功能不全、肺动脉高压者，给予有效的抗感染、强心及利尿剂、降肺动脉压等治疗；加强静脉营养，提高机体免疫力。术中提高手术技巧，操作轻柔，选择合适的手术切口及修补材料，避免发生传导阻滞等并发症。术后入 CICU，加强呼吸道管理，合理使用呼吸机；合理使用血管活性药物，维持循环系统的稳定；合理使用抗生素，减少肺部感染的发生。结果48例中无1例死亡，并发呼吸机相关性肺炎10例，心律失常2例，气胸1例，心包填塞1例，低心排1例。术后随访6个月至6年，生长发育好，无死亡。结论Down 综合征室间隔缺损患儿应尽早手术，选择适当的手术时机，合理有效的围术期处理，可提高手术成功率，延长患儿寿命。
目的：總結 Down 綜閤徵患兒室間隔缺損的外科治療經驗。方法48例 Down 綜閤徵患兒室間隔缺損在全身痳醉低溫體外循環下行一期根治術。術前對于閤併肺部感染、心功能不全、肺動脈高壓者，給予有效的抗感染、彊心及利尿劑、降肺動脈壓等治療；加彊靜脈營養，提高機體免疫力。術中提高手術技巧，操作輕柔，選擇閤適的手術切口及脩補材料，避免髮生傳導阻滯等併髮癥。術後入 CICU，加彊呼吸道管理，閤理使用呼吸機；閤理使用血管活性藥物，維持循環繫統的穩定；閤理使用抗生素，減少肺部感染的髮生。結果48例中無1例死亡，併髮呼吸機相關性肺炎10例，心律失常2例，氣胸1例，心包填塞1例，低心排1例。術後隨訪6箇月至6年，生長髮育好，無死亡。結論Down 綜閤徵室間隔缺損患兒應儘早手術，選擇適噹的手術時機，閤理有效的圍術期處理，可提高手術成功率，延長患兒壽命。
목적：총결 Down 종합정환인실간격결손적외과치료경험。방법48례 Down 종합정환인실간격결손재전신마취저온체외순배하행일기근치술。술전대우합병폐부감염、심공능불전、폐동맥고압자，급여유효적항감염、강심급이뇨제、강폐동맥압등치료；가강정맥영양，제고궤체면역력。술중제고수술기교，조작경유，선택합괄적수술절구급수보재료，피면발생전도조체등병발증。술후입 CICU，가강호흡도관리，합리사용호흡궤；합리사용혈관활성약물，유지순배계통적은정；합리사용항생소，감소폐부감염적발생。결과48례중무1례사망，병발호흡궤상관성폐염10례，심률실상2례，기흉1례，심포전새1례，저심배1례。술후수방6개월지6년，생장발육호，무사망。결론Down 종합정실간격결손환인응진조수술，선택괄당적수술시궤，합리유효적위술기처리，가제고수술성공솔，연장환인수명。
Objective To summarize the experience with the surgical treatment of ventricular septal defect in children with Down syndrome.Methods Forty-eight children with Down syn-drome underwent one-stage radical operation under general anesthesia during hypothermic car-diopulmonary bypass.Patients with lung infection,heart failure,and pulmonary hypertension were given anti-infection,cardiotonics and diuretics,and anti-pulmonary hypertension,respectively.In addition,intravenous nutrition was strengthened and immunity was improved in all patients.Dur-ing operation,gentle operation technique was carried out and appropriate surgical incision and re-pair material were selected to avoid conduction block and other complications.After operation,pa-tients were admitted to CICU,and respiratory tract management and rational use of breathing ma-chine were strengthened.Moreover,vasoactive drugs and antibiotics were rationally used to main-tain the stability of circulatory system and to reduce the incidence of pulmonary infection. Results Among the 48 children,ventilator-associated pneumonia occurred in 10,arrhythmia in 2, pneumothorax in 1,pericardial tamponade in 1,and low cardiac output in 1.These children had normal growth and development and no children died after 6 months to 6 years of follow-up.Con-clusion Early operation,appropriate surgery timing and reasonable and effective perioperative treatment can improve the success rate of operation and prolong the life of Down syndrome chil-dren with ventricular septal defect.
