CAJ | 학술논문

目的探讨婴幼儿大型室间隔缺损(VSD)早期外科手术的适应证、手术时机、术后处理.方法选择确诊为大型VSD并发肺炎患儿88例.其中男53例,女35例;年龄3～18(7.5±2.9)个月;体质量5～13 (7.9 ±1.9)kg.患儿均在全麻加体外循环下行VSD修补术,同期矫治合并的畸形.术中经右心房切口修补58例,经肺动脉切口修补14例,经右心室切口修补16例.88例患儿均采用补片修补,其中78例应用牛心包片修补,10例应用戊二醛处理后的自体心包片修补.术后常规入心脏外科监护室,并酌情应用多巴胺、米力农、肾上腺素等血管活性药物.术后抗感染首先选择小儿内科治疗有效的抗生素,然后根据术后痰培养结果调整敏感抗生素.术后早期开始进行营养支持.结果 88例患儿手术均获成功,术后住院11 ～32(15.2±5.9)d.围术期主要并发症:肺部感染5例,切口愈合不良4例,肺不张、室间隔少量残余分流各3例.患儿均痊愈出院,76例随访1 ～12个月,2例患儿超声心动图仍有少量残余分流,第3例患儿残余分流已消失.76例随访的患儿均无临床症状,其中28例随访患儿术后6个月体质量已达健康儿童水平.全组无其他并发症及死亡.结论早期外科手术是治疗婴幼儿大型VSD患者的一种安全有效的方法.
목적 탐토영유인대형실간격결손(VSD)조기외과수술적괄응증、수술시궤、술후처리.방법 선택학진위대형VSD병발폐염환인88례.기중남53례,녀35례;년령3～18(7.5±2.9)개월;체질량5～13 (7.9 ±1.9)kg.환인균재전마가체외순배하행VSD수보술,동기교치합병적기형.술중경우심방절구수보58례,경폐동맥절구수보14례,경우심실절구수보16례.88례환인균채용보편수보,기중78례응용우심포편수보,10례응용무이철처리후적자체심포편수보.술후상규입심장외과감호실,병작정응용다파알、미력농、신상선소등혈관활성약물.술후항감염수선선택소인내과치료유효적항생소,연후근거술후담배양결과조정민감항생소.술후조기개시진행영양지지.결과 88례환인수술균획성공,술후주원11 ～32(15.2±5.9)d.위술기주요병발증:폐부감염5례,절구유합불량4례,폐불장、실간격소량잔여분류각3례.환인균전유출원,76례수방1 ～12개월,2례환인초성심동도잉유소량잔여분류,제3례환인잔여분류이소실.76례수방적환인균무림상증상,기중28례수방환인술후6개월체질량이체건강인동수평.전조무기타병발증급사망.결론 조기외과수술시치료영유인대형VSD환자적일충안전유효적방법.
Objective To explore the operative indication operation time and post-operative care for infants with large ventricular septal defects (VSD).Methods Eighty-eight infants who suffered from large VSD were selected,male 53 cases,female 35 cases,aged from 3 to 18 months[average (7.5-±2.9) months],weight from 5 to 13 kg [average (7.9 ± 1.9) kg].All patients underwent VSD repair and other accompanied anomaly corrections under cardiopulmonary bypass.Fifty-eight cases were operated through right atrium,14 cases through pulmonary artery and 16 cases through right ventricle.Patch repairs were done in all patients,78 cases given bovine pericardium patches,10 cases given self pericardium patches treated by Glutaral.Patients were sent to the intensive care unit after surgery,vasoactive drugs were used as a routine method.Antibotics were selected based on their sputum cultures postoperatively.Nutritional support was given in the earlier stage.Results There were no hospital death,average hospitalization days were (15.2 ± 5.9) days (from 11 to 32 days).The main complication were pneumonia (5 cases),bad coalesce of incision (4 cases),atelectasis (3 cases),minimal residual shunt of VSD (3 cases).All patients were discharged from hospital,76 cases were followed up from 1 to 12 months,2 cases had residual shunt of VSD,the residual shunt of the other case disappeared;76 patients had no clinical symptom,28 patients body weight returned to normal after 6 months of operation.There was no other complication and death.Conclusion Early surgical treatment for infants with large VSD is a safe and effective way with a better prognosis.