5kg以下婴儿体外循环后严重并发症的处理  

Treatment for post-CPB serious complications in infants weighing less than 5 kg

作　　者：金丹群[1] 朱筱珊[1] 

机构地区：[1]安徽省立儿童医院重症监护室,合肥230051

出　　处：《中国小儿急救医学》2007年第2期122-124,共3页Chinese Pediatric Emergency Medicine

摘　　要：目的 总结我院心脏外科监护室（CICU）5kg以下先天性心脏病患儿体外循环后严重并发症的治疗体会。方法 5kg以下婴儿共52例，1～8月龄，体重2．6～5．0kg，病种包括法洛四联症。完全性房室间隔缺损，右室双出口、完全性肺静脉异位引流，完全性大血管转位，室间隔缺损伴（不伴）房间隔缺损伴（不伴）动脉导管未闭伴重度肺动脉高压。全部患儿体外循环术后均予改良超滤，延迟关胸2例，11例放置临时起搏导线，米力农、多巴胺、呋塞米持续静脉滴注，呼吸机支持时间20．5～362．0h，撤机后全部用鼻塞式持续气道正压通气。结果 术后严重并发症包括毛细血管渗漏综合征4例，低心输出量综合征5例，肺动脉高压危象3例，Ⅱ度以上房室传导阻滞2例，支气管重度外压性狭窄2例。本组死亡4例，病死率8％。结论 术后给予改良超滤、加强各脏器功能支持、营养支持、撤机后鼻塞式持续气道正压通气过渡，及呋塞米给药方式的改进等综合措施的应用明显降低了病死率。Objective To Summarize treatment experiences of eardiopulmonary bypaas（CPB） in infant with congenital heart diseases weighing less than 5 kg. Methods Fifty-two infants with various congenital heart diseases such as TOF, DORV, TAPVC, D-TGA/VSD, VSD/ASD/PDA/PH, aged 1 - 8 months and weighing 2.6- 5.0 kg, underwent open heart surgery with eardiopulmonary bypass. Modified ultrafiltration was applied in all eases after eardiopulmonary bypass. Of the 52 eases, 2 underwent delayed sternal closure, 11 was performed with temporary pacemaker lead. The duration of mechanical ventilation was 20.5 ～362.0 hours. Continuous positive airway pressure（CPAP） was used in all patients after weaning from ventilator. Milrinone, Dopamine and Lasix was administered selectively based on the condition of heart function. Results The postoperative severe complications included systemic capillary leak syndrome（SCLS） （4 eases）, low eardiae-output syndrome （5 eases）, pulmonary hypertension crisis（3 eases）, third degree atrioventrieular block（ 1 ease） and serious bronchial stenosis induced by extrinsic compression （2 eases）. Four eases died and the mortality rate was 8 %. Conclusion The mortality can be reduced remarkably by taking the comprehensive measures such as modified ultrafiltration, CPAP after weaning from ventilator, vital organ support, improvement in the Lasix administration, etc.

关 键 词：婴儿 先天性心脏病 体外循环 并发症 

分 类 号：R726[医药卫生—儿科]