摘要目的:探讨先天性心脏病室间隔缺损(VSD)合并中重度肺动脉高压的外科治疗及围术期处理.方法:全组108例,年龄4～96(24.5±16.8)个月,体重4.7～20(11.4±6.8)kg.均有明显临床症状.其中32例为双动脉干下型VSD,其中4例伴有主动脉瓣脱垂和中度以上主动脉瓣返流.32例双动脉瓣下型VSD经肺动脉横切口,其他经右心房切口54例,右心室切口18例,另4例经右房右室双切口完成修补.结果:全组无死亡,2例发生右侧气胸,5例有左侧肺不张,无其他严重并发症.均顺利撤离呼吸机,拔除气管插管.结论:室间隔缺损合并中重度肺动脉高压的外科治疗,其成功的关键在于手术适应证掌握正确,术前准备充分,手术技术进步以及术后处理适当.

abstractsObjective:To explore the surgical treatment of ventricular septal defects(VSD) with moderate or severe pulmonary hypertension. Methods:The open heart operation for closure of VSD was performed on 108 infants.Their ages were 24.5±16.8 months and weight was 11.4±6.8 kg.The types of VSD were subarterial in 32 infants and perimembranous in 76.According to informations from echocardiography,47 cases were associated with moderate pulmonary hypertension and the other 61 with severe pulmonary hypertension.Incisions were made on pulmonary artery(32),right atrium(54),right ventricle(18)and on both right atrium and right ventricle (4).Results:No perioperative death occurred.All patients were weaned from mechanical ventilation in 4～36 hours.Main complications were right pneumothorax in 2 infants and left pulmonary atelectasis in 5.Conclusions:Proper perioperative management is very important to the surgical treatment for VSD with moderate or severe pulmonary hypertension in infancy.