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目的探讨大型室间隔缺损(VSD)并肺炎婴幼儿早期手术治疗的可行性、手术时机、适应证以及术中术后的处理。方法选择2009年10月-2010年7月本院收治的大型VSD并肺炎患儿19例。男11例,女8例;年龄3～15(7.3±2.8)个月;体质量5～12(7.6±1.4)kg。其中VSD并房间隔缺损5例、并动脉导管未闭1例;膜周部VSD16例,肺动脉瓣下VSD3例。患儿均在低温、体外循环、冷晶体停跳液灌注下行VSD直视修补术及并发畸形矫治。16例膜周部VSD患儿均经右房切口修补;3例肺动脉瓣下VSD患儿中,2例经肺动脉横切口修补,1例经右室流出道切口修补。19例患儿VSD修补均采用补片修补法,其中15例应用牛心包补片,4例应用自体心包补片(戊二醛固定)。患儿术中均应用膜式氧合器和术中平衡超滤。结果 19例患儿手术均获成功,术后主要并发症为肺部感染3例,切口愈合不良2例,肺不张和室间隔少量残余分流各1例,无全身感染、肺动脉高压危象以及严重低心排病例,19例患儿均治愈出院。门诊随访2～6个月,上呼吸道感染显著减少,营养发育状况改善。结论把握手术时机和适应证,早期手术、防治术中和术后肺损伤,是治疗大型VSD并肺炎婴幼儿的有效方法。
Objective To investigate the feasibility of early surgical treatment of large ventricular septal defect (VSD) and pneumonia in infants and young children, the timing of surgery, indications and postoperative management. Methods From October 2009 to July 2010, 19 children with large-scale VSD and pneumonia were admitted to our hospital. There were 11 males and 8 females; their ages ranged from 3 to 15 (7.3 ± 2.8) months; their body weights ranged from 5 to 12 (7.6 ± 1.4) kg. VSD and atrial septal defect in 5 cases, and patent ductus arteriosus in 1 case; peritoneal VSD in 16 cases, 3 cases of pulmonary valve under VSD. Children were in hypothermia, cardiopulmonary bypass, cold crystal suspension blood perfusion down VSD direct repair and deformity correction. Sixteen patients with perimembranous VSD were repaired by right atrium incision. Of the three patients with pulmonary subarachnoid VSD, two were repaired by pulmonary artery transverse incision and one was repaired by right ventricular outflow tract incision. 19 cases of children with VSD repair patch repair method, of which 15 cases of bovine pericardium patch, 4 cases of autologous pericardial patch (glutaraldehyde fixation). Children with intraoperative membrane oxygenator and intraoperative balance of ultrafiltration. Results All the 19 cases were operated successfully. The main complications were 3 cases of lung infection, 2 cases of poor incision healing, 1 case of atelectasis and a few residual ventricular septum, no systemic infection, pulmonary hypertension crisis and serious Low heart row cases, 19 patients were cured and discharged. Out-patient follow-up of 2 to 6 months, significantly reduced upper respiratory tract infection, nutritional status improved. Conclusion Grasp the timing and indications of surgery, early surgery, prevention and treatment of intraoperative and postoperative lung injury, is an effective method for the treatment of large-scale VSD and pneumonia in infants.