新生儿主动脉弓手术的体外循环管理体会

摘要

目的：探讨新生儿主动脉弓离断（IAA）或主动脉缩窄（CoA）合并其它心内畸形的一期矫治手术的体外循环管理。方法2014年9月至2015年7月手术治疗主动脉弓离断或缩窄合并其它心内畸形新生儿14例，其中主动脉缩窄6例，主动脉弓离断8例。平均年龄17（3～30） d。平均体重3．06（2．1～4．2）kg。均经胸骨正中切口在深低温体外循环下行一期矫治手术。结果14例新生患儿均顺利完成手术，顺利脱离体外循环，平均体外循环时间141（66～410） min，平均停循环时间17（15～30）min，平均阻断时间60（32～134）min，辅助时间69（28～284）min。其中有2例延迟关胸，14例手术开放后均尿量满意，无需进行改良超滤，无需放腹膜透析。结论新生儿的体外循环管理，尤其是深低温停循环的体外循环管理，从做好预充液的调整到体外循环的全程控制，会对手术结局起到非常重要的作用，患者有更好的转归。%Objective The aim of the study was to examine the management and the experience of cardiopulmonary bypass ( CPB) in one stage repair of interrupted aortic arch or aortic coarctation with intracardiac defects in neonates. Methods One stage re⁃pair were performed in 14 neonates with interrupted aortic arch( IAA) or aortic coarctation( CoA) with other intracardiac defects from September 2014 to July 2015. The cases included 6 neonates with aortic coarctation of aortic arch and 8 with IAA. Median age was 17 (3-30) days. Median weight was 3.06(2.1-4.2)kg. Results Deep hypothermia circulatory arrest(DHCA) was used in all cases. The median CPB time 141(66-410) min, median DHCA time was 17(15-30) min, and aortic cross clamping time was 60(32-134)min, and continuous CPB time 69(28-284)min. All the cases were weaned from CPB successfully without modified ultrafiltration and perito⁃neal dialysis. The postoperative complication occurred in 2 cases with delayed sternal closure. Conclusion It is important to intensify the total process of CPB management in the neonates to ensure surgical safety, especially the management of DHCA.