小儿体外循环若干问题的探讨  

Exploration of the Problems of Cardiopulmonary Bypass in Children

作　　者：傅惟定[1] 朱德明[1] 陈虹[1] 张蔚[1] 王伟[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心,上海200127

出　　处：《苏州大学学报（医学版）》2006年第1期105-106,143,共3页Suzhou University Journal of Medical Science

摘　　要：目的介绍2004年1月19日至21日美国波士顿儿童医院小儿心脏外科专家组来该院手术演示中的体外循环管理策略。方法各种先天性心脏病手术5例，均使用进口膜式氧合器。最低预充量550ml。中度低温中流量4例，深低温低流量1例。全部采用冷晶体心肌保护液。常规超滤3例，常规／改良结合1例，平衡超滤1例。结果主动脉阻断时间39～92min，体外循环时间62～122min，全部自动复跳。尿量排出满意。转流过程平稳，未出现与体外循环相关的故障和并发症，全部顺利停机，痊愈出院。结论血气管理宜采用α和pH稳态相结合，转流中维持较高的红细咆压积和灌注流量，注重脑保护。常规超滤用细管连接血液浓缩器两端在采药板动静脉插口间进行。Objective To explore the management of cardiopulmonary bypass demonstrated by the purfusionist of the Boston Children Hospital during their visit on January 2004. Methods There were 5 children with serious congenital heart diseases undertaken the procedure. All of them used imported mebrane oxygemator. The lest prime was 550 ml. Four patients received treatment with moderate temperature and flow. One patient received deep hypothermia with low flow. All children received cool crystalloid cardioplegia. Three patents received conventional ultrafiltration （CUF）, and 1 patients used modified ultrafiltration （MUF） with CUF. One patients receved balanced utrafiltration （BUF）. The duration of CPB ranged from 62 to 122 min and the time of aortic cross clamping was between 39 to 92 min. Results All chidren had spontaneous resuscitation. The duations of the bypass was safe with no hemoglobinuria or other complications. Conclusion Blood gas use α-pH star and CUF （hemoconsentrator is connected between A-V port at durg deck）, Higher hematocrits and flow rate are important factors for brain protection for children who receive bypass procedure.

关 键 词：体外循环 血气管理 心肌保护 红细胞压积 超滤 

分 类 号：R726.541[医药卫生—儿科]