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目的:总结婴幼儿大型室间隔缺损合并肺动脉高压的外科治疗经验。方法:婴幼儿大型室间隔缺损134例,其中合并房间隔缺损16例、三尖瓣关闭不全14例、动脉导管未闭18例,患儿均在全身麻醉低温体外循环下行一期矫治术。结果:本组8例死亡,术后并发症35例,其中低心排出量综合征16例、肺不张6例、肺炎5例、心律紊乱5例、气胸3例,术后早期复查彩超,除5例有少量残余分流外,余患儿心功能及瓣膜关闭均正常。结论:低体质量、小年龄的大型室间隔缺损应尽早手术根治;术中减轻体外循环损伤、注重脏器功能保护,术后加强呼吸道管理、预防低心排出量综合征和肺动脉高压危象是降低并发症的关键。
Objective: To summarize the experience of surgical treatment of large ventricular septal defect with pulmonary hypertension in infants and young children. Methods: 134 cases of large ventricular septal defect in infants and young children, including atrial septal defect in 16 cases, tricuspid regurgitation in 14 cases, patent ductus arteriosus in 18 cases, children underwent general anesthesia with hypothermia cardiopulmonary bypass an orthodontic treatment. Results: There were 8 deaths and 35 postoperative complications in this group, including 16 cases of low cardiac output syndrome, 6 cases of atelectasis, 5 cases of pneumonia, 5 cases of cardiac arrhythmia, 3 cases of pneumothorax and early postoperative ultrasound screening, In addition to a small amount of residual shunt in 5 cases, I still had normal heart function and valve closure. Conclusions: Large-scale ventricular septal defect with low body mass and small age should be operated as soon as possible. It is effective to relieve extracorporeal circulation injury, protect organ function, enhance respiratory tract management, prevent low cardiac output syndrome and pulmonary hypertension crisis after operation The key to reduce complications.