39例大型房间隔缺损 室间隔缺损并发肺炎婴儿早期手术治疗的临床分析

Early surgical treatment for infants with large atrial septal defects or ventricular septal defects complicated by pneumonia: experience of 39 cases

摘要:

目的：婴儿大型房间隔缺损(ASD)室间、隔缺损(VSD)难以自愈，需要尽早手术纠治，以免影响发育甚至导致死亡。但是这类患儿往往并发严重的肺部感染，且反复发作，很难等到肺部感染完全治愈时进行手术纠治。同时患儿需要反复治疗肺炎，费用较高且易延误手术时机。因此，该文研究婴儿大型房间隔缺损、室间隔缺损并发肺炎的早期手术治疗的手术时机选择、治疗的可行性以及减少并发症的处理。方法：2003年1月至2008年 1月，收治大型ASD, VSD并发肺炎39例婴儿，36例在肺炎控制后进行早期手术治疗，3例再行儿科保守治疗。结果：手术病例中， 33例婴儿手术成功， 2例婴儿死于气管狭窄， 1例死于严重低心排， 死亡率8.3%。儿科保守治疗病例中，1例在治疗中因心肺衰竭死亡 ；2 例好转出院，择期行手术治疗成功。结论：把握手术时机和适应证，做好围术期处理，在肺炎控制后对大型ASD，VSD的婴儿进行早期手术治疗是可行的，可提高和改善治疗效果并减少患者费用

Abstract:

OBJECTIVE: This research reported the experience of early surgical treatment for infants with large atrial septal defects (ASD) or ventricular septal defects (VSD) complicated by pneumonia.METHODS: Between January 2003 and January 2008, 39 infants with large ASD or VSD complicated by pneumonia were admitted to the Second Xiangya Hospital. Thirty-six patients underwent surgical repair within 7-10 days after pneumonia had been controlled. Mean age was 5.4±3.4 months and mean weight was 4.7±1.6 kg in the 36 patients. Three patients received conservative treatment due to uncontrolled lung infections.RESULTS: Of the 36 patients, 33 had successful surgery and 3 (8.3%) died of serious low cardiac output (n=1) or respiratory failure due to congenital tracheostenosis (n=2). The 33 survivors showed normal growth and development in a 6 month-5 year follow-up. Of the 3 patients receiving conservative treatment, 1 died of cardiopulmonary failure and 2 were discharged after the symptoms had been improved. CONCLUSIONS: With increasing medical experience and technique, early surgical operation may be performed with good outcomes in infants with large ASD or VSD complicated by pneumonia.