摘要
为提高小儿室间隔缺损(VSD)伴肺动脉高压(PH)的手术成功率,回顾分析得出1973～1987年和1988～1995年,共2426例患儿手术死亡率各为5.7%和0.73%:伴 PH 者736例,手术死亡率由16.8%降至1.69%;危重型急诊手术死亡率9%;62例 VSD/PH 肺活检光电镜显示各年龄组都有不同程度肺血管病变:>5岁的患者36.8%为不可逆病变:肺小动脉数量减少15%～40%,肌层向肺泡动脉延伸是最早期改变。重度 PH者术后易发生肺高压危象。小儿 VSD 有肺高压趋势者宜1岁内纠治,有危重症状者不论年龄均应急诊或亚急诊手术;伴 PH 者围术期预防和处理反应性肺高压至关重要。
In order to improve the results of surgical repair of the VSD associated with pu- lmonary hypertension (PH),we retrospectively analyzed the data of 2426 cases who received VSD repairing from 1973 to 1995,the surgical mortality between 1973 and 1987 was 5.7% and 0.73% between 1987 and 1995;among 736 cases with PH,the mortality dropped from 16.8% to 1.69 % in later term,the mortality of emergent procedure was 9%;all the 62 biopsies of VSD/PH under electronic and/or optical microscopy showed pulmonary vascular disease in each age group at different degrees, 36.8% of children elder than five years had irreversible lesions with a decrease in the number of arterioles by 15%～40%,and the extending muscle into alveolar was the earliest alterations,the severe VSD/PH was prone to be tripped by pulmonary hypertensive crisis.It is the wise choice to repair the VSD with tendency of pulmonary hypertension within the first year of life.If with critical symptom emergent or semi-emergent operation should be taken in spite of any age;it is of paramount importance to prevent and treat the pulmonary hypertension crisis in the perioperative period.
出处
《上海第二医科大学学报》
CSCD
1998年第5期360-362,共3页
Acta Universitatis Medicinalis Secondae Shanghai
基金
上海市教育委员会基金项目资助(94C12)
关键词
先天性心脏病
室间隔缺损
肺动脉高压
外科手术
ventricular septal defect
pulmonary hypertension
pulmonary vascular disease
operative repair
