中度低温脑灌注技术在婴幼儿一期主动脉弓部重建术中的应用  

Clinical Application of Moderate Hypothermia Cerebral Perfusion in Intracardiac Malformation Surgery for Aortic Coarctation in Infants

作　　者：倪虹[1] 扬璟[1] 刘凤珍[1] 刘晓明[1] 缪娜[1] 侯晓彤[1] 

机构地区：[1]首都医科大学附属北京安贞医院体外循环科,北京100029

出　　处：《实用儿科临床杂志》2011年第13期1042-1044,共3页Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(81070203)

摘　　要：目的总结中度低温停循环(MHCA)结合选择性脑灌注(ASCP)技术在婴幼儿一期主动脉弓部重建中的临床效果。方法回顾分析本院2009年1月-2010年12月行一期主动脉弓重建的动脉弓缩窄合并心内畸形30例患儿的临床资料。患儿平均年龄10个月(16 d^8岁),体质量3~22(6.3±3.3)kg。30例患儿体温均降至鼻咽温23~26℃,直肠温度24~28℃,患儿均在术中采用MHCA,通过无名动脉进行ASCP(20~30 mL.kg-1)的体外循环(ECC)方法。心肌保护均采用康斯特保护液(HTK液)。患儿均采用术中常规超滤及术后改良超滤。结果患儿均无与ECC相关的神经系统并发症,无死亡病例。ECC时间为65~170(123±23)min,主动脉阻断时间为16~95(53±18)min,ASCP时间为10~50(25±8)min,自动复跳率100%。患儿术后常规镇静清醒时间为6~95(46±26)h,机械通气时间为8~96(44±23)h,ICU滞留时间为1~12(5.5±3.5)d,住院时间为10~58(32±14)d。结论 MHCA结合ASCP等综合保护策略应用于婴幼儿一期主动脉弓重建手术中,有助于脑及重要脏器的保护,是安全可行的ECC方法。Objective To summarize the clinical effect of moderate hypothermia circulation arrest（MHCA） combining with antegrade selective cerebral perfusion（ASCP） to fulfill cerebral protection in intracardiac malformation surgery for aortic coarctation（CoA） in infants.Methods The clinical data of 30 infants with CoA undergoing aortic arch reconstruction surgery in Beijing Anzhen Hospital from Jan.2009 to Dec.2010 were analyzed.The mean age was 10 months old（16 days-8 years） and weights were 3-22（6.3±3.3） kg.MHCA was applied for all patients by cooling down to 23-26 ℃ of nasopharyngeal temperature and 24-28 ℃ of rectal temperature,and perfusion through innominate artery at 20-30 mL·kg-1 during procedures.Histidine-tryptophan-ketoglutarate（HTK） solution was used for myocardial protection.Conventional ultrafiltration（CUF） and modified ultrafiltration were applied for all patients as well.Results All patients had no death and neurological complications related to extracorporeal circulation（ECC）.ECC lasted 65-170（123±23） min with aortic arrest time of 16-95（53±18） min,and ASCP was 10-50（25±8） min.All hearts returned beating spontaneously.General sedation was used post-operation.Ventilator time was 8-96（44±23） h.Patients waked from anesthesia in 6-95（46±26） h and stayed for ICU for 1-12（5.5±3.5） d and in hospital for 10-58（32±14） d.Conclusions In aortic arch reconstruction for infants with CoA and intracardiac malformation,the application of MHCA combining with ASCP during procedure are safe and feasible ECC management and helpful for cerebral protection.

关 键 词：中度低温停循环 选择性脑灌注 主动脉弓部重建 脑保护 体外循环 

分 类 号：R726.5[医药卫生—儿科]