目的：总结和探讨低体重紫绀型婴幼儿先天性心脏病手术的围术期麻醉管理方法。方法回顾分析2012年5月至2014年12月26例紫绀型婴幼儿[年龄3～24（9）个月，体重3．4～10（7．73±1．8）kg]先心手术的临床资料。除常规监测外均行有创动脉压和中心静脉压监测，诱导后行机械通气，全凭静脉维持麻醉。记录体外循环时间、升主动脉阻断时间、输血量、术后拔管时间、并发症和死亡率。结果平均体外循环时间（133．8±28．4）min，升主动脉阻断时间（92．2±23）min。术后5例发生低心排综合征，4例发生气胸；3例行二次气管插管；3例行床旁腹膜透析；术后拔管时间73．7（6．8～211．5）h；无1例死亡。结论合理调控分流量和方向以维持氧合和循环稳定，预防和避免术后肺部并发症和低心排综合征是保证低体重紫绀型婴幼儿先天性心脏病手术围术期安全和提高预后的关键。%Objective To summarize the anesthesia management strategies for cardiac procedures in infants of low body weight with cyanotic congenital heart disease. Methods Twenty six infants [9(3-24)Mouth, Weight 7.73±1.8(3.4-10)kg] received surgi⁃calrepair of cyanotic congenital heart disease fromMay 2012 to December 2014were retrospectively analyzed. All received fast track in⁃duction and totally intra-venous anesthetic maintenance and continuous monitoring of the invasive blood pressure and the central venous pressure during the operation was conducted. The data of cardiopulmonary bypass and aortic cross clamping times, transfusion, me⁃chanical ventilation times, complications and mortality was recorded during the perioperative period. Results All infants were smooth⁃ly operated on.The mean cardiopulmonary bypass time was 133.8±28.4 min, and aortic cross clamping time was 92.2±23 min. After the operation, the mechanical ventilation support was continued 73.7 (6.8-211.5)hours. low cardiac output syndromes occurred in 5 in⁃fants and 4 cases of pneumothorax, 4 cases of peritoneal dialysis and 3 cases of reintubation were noted and no infants died post-opera⁃tively. Conclusion The infants of low body weight with the complicated cyanotic congenital heart disease have critically illcondition before the operation. Reasonable management to regulation the bypass direction and volumes to maintain the satisfactory oxygenation and hemodynamic stability, while avoidingpulmonary complication and low cardiac output syndrome postoperatively, are the key points to ensure perioperative security and improve patient's prognosis.
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