婴幼儿右腋下小切口微创心内直视手术的体外循环管理

摘要

目的 总结婴幼儿右腋下小切口微创心内直视手术的体外循环(Cardiopulmonary bypass,CPB)管理经验.方法 在142例婴幼儿右腋下小切口微创心内直视手术中,采用复方电解质注射溶液、红细胞、血象、20％人血白蛋白、万汶等预充,血液稀释后红细胞压积20％～30％.CPB采用常温60倒,浅低温67倒,中低温15例,心肌保护应用高钾晶体停搏液.结果 主动脉阻断时间0～45(26.28±7.55)min; CPB时间20～65(39.28±10.66)min;呼吸机辅助时间1.5～8(3.6±1.38)h;监护时间8～48(34.01±11.00)h.术后胸引量10～100(37.35±21.72)m1. 60例不停跳、82例停跳手术均自动复跳.5例出现皮下气肿,无其它并发症发生,均痊愈出院.结论 婴幼儿右腋下小切口微创心内直视手术术中注意重要脏器保护、选择合适流量和个体化管理是手术的安全保障.%Objective To summarize the experience of cardiopulmonary bypass for open-heart surgery in infant with right subaxillary minimal invasive thoracotomy. Methods 142 patients underwent open heart surgery through sub-axillary mini-thoracotomy. 70 cases suffered from ventricular septal defect (VSD) and 51 cases suffered from with atrial septal defect (ASD) and 10 cases suffered from both VSD and ASD and 6 cases suffered from both VSD and tricuspid insufficiency and 5 cases suffered from partial atrioventricular septal defect. Priming solusion was composed of compound electrolytes injection solution, red blood cell, plasma, 20% human albumin, Voluven and so on to keep haematocrit 20% ~30%. CPB with normal temperature was in 60 cases and CPB with mild hypothermia was in 67 cases and CPB with moderate hypothermia was in 15 cases. All the cases were applied with cold high potassium crystal myocardial preservation solution. Results Aortic cross clamping time were 0-45(26. 28±7. 55)minutes; the mean CPB time were20 -65 (39. 28±10. 66)minutesi the postoperative average mechanical ventilation time werel. 5~8(3. 6±1. 38)ht The time of ICU stay were8~48(34. 01±11.00)h; The average volume of postoperative drainage were 10~100(37. 35±21. 72)ml. Beating cardiac operation was performed in 60 cases and operation under cardiac arrest was performed in 82 cases which got fully re-beating. All cases got fully recovery except for 5 cases complicating subcutaneous emphysema. Conclusion Protection of key organs and appropriate flow volume and personal management ensure safety of operation for open-heart infants with right subaxillary minimal invasive mini-thoracotomy.