全腔肺动脉连接术的体外循环管理  

Extracorporeal Circulation Management of Total Cavopulmonary Connect Operation

作　　者：李平[1] 董念国[1] 高思海[2] 孙宗全[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院心外科,武汉430022 [2]华中科技大学同济医学院附属同济医院心胸外科,武汉430030

出　　处：《华中科技大学学报（医学版）》2012年第1期110-111,126,共3页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.30500656)

摘　　要：目的总结全腔肺动脉连接术体外循环转流的方法与经验。方法全组26例均在全麻体外循环下行全腔肺动脉连接术,麻醉诱导后放血,使红细胞压积稀释到术前的50%～60%。预充液中加入血浆和白蛋白等胶体液使晶胶比值维持在0.5～0.6,胶渗压16～18mmHg;实施浅低温体外循环,灌注流量2.4～2.8L/(m2.min),维持平均动脉压40～60mmHg。心脏复温时,启动常规超滤并再次加入血浆和白蛋白,提高红细胞压积(HCT)和胶体渗透压,通过增加血容量和提高血浆胶体渗透压来适应新的血流动力学变化。停机时"置换性"的超滤使得血红蛋白浓缩至35%～45%,血浆胶体渗透压至18～21mmHg。结果该组4例患者死于术后低心排血量,余22例患者均存活痊愈出院,体外循环期间血流动力学基本稳定,血气电解质维持在正常范围,术后SaO2≥92%,中心静脉压(CVP)15～17cmH2O。结论停机前加入大量的血浆和白蛋白以增加血容量、提高并长时间维持胶体渗透压以适应新的血流动力学变化,保持机体内环境稳定是全腔肺动脉连接术中体外循环管理的关键。Objective To sum up the methods and experience concluded from extracorporeal circulation performed on 26 patients during total cavopulmonary connect operation.Methods All the 26 patients were subjected to total cavopulmonary connect operation in light hypothermia extracorporeal circulation.Hct was reduced to 50%-60% of that preoperation by bloodletting.During the course,the function of patients,heart,brain,lung,kidney and blood was preserved by carrying out high volume of plasma and albumin was added before termination of bypass for maintaining the ratio of crystal and colloid osmotic pressure to 0.5-0.6 and maintaining colloid osmotic pressure 16-18 mmHg.During the light hypothermia extracorporeal circulation,the flow rate of perfusion was maintained at 2.4-2.8 L/（m2·min）and mean blood pressure at 40-60 mmHg.Application of ultrafiltration and high volume of plasma and albumin before termination of bypass was essential to maintain the ratio of crystal and colloid osmotic pressure to adapt the changes of hemodynamics.Carrying out ＂exchange ultrafiltration＂ before termination of bypass could maintain Hct 35%-45% and colloid osmotic pressure 18-21 mmHg.Results Four patients died of low cardiac output,and 22 patients survived.Among the 22 patients,the hemodynamics and blood gas electrolyte were kept in a normal extent during the course,and oxygen saturation was over 92% and CVP was 15-17 cmH2O after operation.All the 22 patients recovered and discharged from hospital.Conclusion It is very important that high volume of plasma and albumin are added before termination of bypass for maintaining the ratio of crystal and colloid osmotic pressure to adapt the changes of hemodynamics.All above are keys to perform the extracorporeal circulation during total cavopulmonary connect operation.

关 键 词：先天性心脏病 全腔肺动脉连接术 体外循环 

分 类 号：R541[医药卫生—心血管疾病]