深低温停循环在新生儿及婴儿复杂先心病手术中的应用  

The clinical application of DHCA in neonates and infants with complex congenital heart disease

作　　者：王振祥 吴莉莉 乔彬 段海云 

机构地区：[1]106医院心脏外科,心脏外科研究中心,山东济南250022

出　　处：《实用医药杂志》2004年第8期686-687,691,共3页Practical Journal of Medicine & Pharmacy

摘　　要：目的总结我院1998-01～2004-01实施的6月龄以下复杂先心病婴儿深低温停循环(DHCA)手术81例。方法年龄12h至6个月,平均3.38±0.47个月。体重2.5～6.5kg(4.31±1.73kg)。采用减少晶体预充量、预充白蛋白、控制降温速度、低温期采用pH稳态血气管理以及应用扩血管药物硫喷妥钠;局部降温,应用常规超滤(CUF)和改良超滤(MUF)等综合措施。术中Hct0.16～0.27(22.47±2.31)。DHCA期间温度14.5～21℃(17.34±1.37℃)。DHCA时间7～72min(43.38±6.43min)。治愈组与死亡组DHCA时间比较分析。结果全组未发现明显神经系统并发症。治愈组与死亡组DHCA时间比较无显著性差异(P>0.05),显示DHCA时间与死亡率无显著相关性。结论在新生儿及婴儿DHCA手术中,方法应用得当,可避免神经系统并发症的发生。Objective To summarize the clinical usage of deep hypothermic circulatory arrest (DHCA) in neonates and infants less than 6 months with complex congenital heart disease. Methods The 81 cases, aged 12h-6m (3.38±0.47m) and weight 2.5-6.5kg (4.31±1.73kg), were operated on with DHCA from Jan, 1998 to Jan, 2004. Many measures were taken in the operations including decreasing priming crystalloid liquid, priming human albumin, controlling the cooling speed, using pH-stat blood gas management during th hypothermic time, applying vasodilator and thiopental sodium, regional myocardiac colding, performing CUF and MUF, etc. In the operations, the hemotocrit ranged from 0.16 to 0.27 (22.47±2.31) and the temperature during the DHCA ranged from 14.5 to 21 ℃ (17.34±1.37℃). The DHCA time ranged from 7 to 72min (43.38±6.43min) and was performed a statistical analysis between the cure group and the death group. Results No obvious nervous syestem complications occurred in the series. And there was no significant difference of the DHCA time between the two groups, i.e it had no relation to the mortality. Conclusion Through applying appropriate methods, the neurological dysfunction associated to DHCA can be avoided in the pediatric (neonate and infant) operations.

关 键 词：深低温停循环 脑保护 婴儿 复杂先心病 心脏外科手术 

分 类 号：R541.1[医药卫生—心血管疾病]