高原地区先天性心脏病手术的体外循环管理

摘要

Objective To study extracorporeal circulation ( ECC) management for congenital heart disease operation in patients from plateau area .Methods A total of 68 patients from plateau area with congential heart disease underwent cardiac defect repair under ECC in our hospital .Severe pulmonary hypertension ( PH) was found in 4 cases, moderate PH in 8 cases and mild PH in 11 cases.During the operation, the conventional ECC was established , 20%protein and high dose of ulinastatin (UTI),methylprednisolone (MP), and 5% NaHCO3 were administered according to arterial blood gas (ABG) results.Ultrafiltration and modified ultrafiltration were used in patients with moderate to severe PH . Results The ECC time was 35-86 min [mean (45.1 ±10.5) min].The aortic cross-clamp time was 21-50 min [mean (28.3 ±9.8) min].The ABG results were normal.The pulmonary artery pressure dropped after ECC .The mean pulmonary artery pressure(MPAP)was decreased (P<0.05).There was no death during the operation .Conclusion Selecting suitable priming fluid , applying ultrafiltration technique and strengthening organ protection are effective methods in ECC management of congenital heart disease in plateau area .%目的：总结高原地区先天性心脏病手术的体外循环管理。方法回顾性分析我院为高原地区先天性心脏病的体外循环手术患儿68例。术前经超声心动图检查存在房间隔缺损、室间隔缺损，其中合并轻度肺动脉高压11例、中度8例、重度4例。体外循环采用浅低温和轻度血液稀释，预充液中均加入20％白蛋白及甲泼尼龙2 mg／kg，转流中给予碳酸氢钠；先天性心脏病合并中重度肺动脉高压病例预充乌司他丁10000 U／kg，均使用超滤或改良超滤技术。结果体外循环时间35～86 min，平均（45．1±10．5） min，主动脉阻断时间21～50 min，平均（28．3±9．8） min；血气、电解质监测结果在正常范围；停机后先天性心脏病合并肺动脉高压病例平均肺动脉压（MPAP）均有不同程度降低（P＜0．05）。全组均实现早期拔管，术后早期全部生存。结论对于高原地区先天性心脏病合并肺动脉高压手术中的体外循环管理，除常规麻醉用药、手术矫正畸形及术后药物纠正肺动脉高压外，在体外循环中增加胶体预充，应用大剂量激素及乌司他丁，给予碳酸氢钠及使用超滤技术，能够取得满意的临床效果。