10kg以下低体重婴幼儿先天性心脏病体外循环管理

摘要

目的 总结2009年2月～8月36例10 kg以下低体重婴幼儿先天性心脏病体外循环管理方法.方法 各种先天性心脏病心内直视手术36例,月龄为1～36个月,平均(10.6±5.3)个月;体重3～10 kg,平均(7.2±1.8)kg.均使用进口膜式氧合器,预充液总量为400～550 ml.浅低温高流量灌注26例,中低温中流量灌注7例,低温低流量灌注2例,DHCA 1例.全部采用4:1含血心肌保护液.中术及术后采用改良超滤结合常规超滤.结果 本组体外循环转流时间为26～192 min,平均73 min,升主动脉阻断时间为9～109 min,平均41 min.转中尿量满意,转流过程平稳,未出现与CPB相关故障和并发症,心脏全部自动复跳,全部顺利脱机.35例痊愈出院,1例死亡.结论 低体重婴幼儿应根据病种及手术方式采取不同体外循环方法,尽量减少预充量,加强液体出入量平衡的管理,以及良好的心肌保护和脏器保护有助于提高手术成功率.%Objective To summarize the experiences of extracorporeal circulation management during open heart surgery in infants with congenital heart disease( CHD )weighing below 10 kg.Methods 36 CHD infants undergoing open heart surgery from February to August in 2009 were included in this study.They were 1 - 36 month old( 10.6 ± 5.3 ) month on average and 3 - 10 kg weight( 7.2 ± 1.8 )kg on average.An imported membrane oxygenator was applied and the total volume of priming solution was 400 - 550 ml during this surgery.High flow perfusion under light hypothermia was performed in 26 cases, middle flow perfusion under moderate hypothermia in 7 cases, low flow perfusion under hypothermia in 2 cases, and one case were operated under deep hypothermia and circulatory arrest( DHCA ).All the perfusions were done with 4∶1 of myocardial protective solution containing blood.Modified ultrafiltration combined with common ultrafiltration was performed intraoperatively and postoperatively.Results Cardiopulmonary bypass( CPB )lasted for 26 - 192 min with an average of 73 min.Ascending aorta was clamped for 9 - 109 min with an average of 41 min.Urine volume was satisfying, and no related malfunctions or complications occurred during CPB.All infants'hearts spontaneously beat again and were off CPB successfully.35 cases were healed and discharged; only one case was dead.Conclusion Different extracorporeal circulation measures should be taken according to the variety of CHD and operative procedure in underweight infants during open heart surgery.Lower volume of priming solution, balanced intake and output fluid, and favorable protection of nyocardium and organs can be conducive to the success of this surgery.