低体重婴幼儿的体外循环特点和管理策略  

Extracorporeal circulation in low birth weight infants

作　　者：黄国栋 曹凡 

机构地区：[1]广东省广州市妇女儿童医疗中心心脏中心,510623

出　　处：《广东医学》2013年第9期1352-1355,共4页Guangdong Medical Journal

摘　　要：目的总结体重在5 kg以下的先天性心脏病(以下简称先心病)婴幼儿行心内直视手术的体外循环(ECC)管理体会。方法 881例年龄在11 h至1岁1个月,平均(74.31±57.53)d,体重0.7～5 kg,平均(4.12±0.68)kg的先心病婴幼儿在ECC下行心内直视手术,预充液为复方电解质注射液(勃脉力A)、红细胞、血浆及甲泼尼龙、碳酸氢钠、甘露醇、硫酸镁、呋塞米、白蛋白、肝素等,ECC中维持灌注流量20～200 mL/(kg.min),平均动脉压25～40 mmHg,心肌保护采用主动脉根部灌注冷康斯特保护液(HTK液)25～50 mL/kg,行常规超滤和改良超滤。结果 ECC时间13～529 min,平均(89.42±57.50)min,升主动脉阻断0～218 min,平均(44.27±27.99)min,ECC过程平稳,术中死亡4例,术后死亡20例,其余患儿顺利康复出院。结论合理的预充,确切的心肌保护,ECC中维持合理的灌注流量,行常规超滤和改良超滤,是应用于低体重婴幼儿的ECC管理行之有效的方法。Objective To summarize the clinical experience of extracorporeal circulation （ECC） in 881 cases of low birth weight infants （ 〈 5 kg, LBWIs）. Methods A total of 881 LBWIs [ weight 0. 7 - 5 （4. 12 ± 0. 68 ） kg ] with congenital heart disease [age ranged from 11 hours to 1 year and 1 month, （74. 31 ±57. 33） days] were operated under hypothermic with ECC. The prime liquid were multiple electrolytes injection, RBC and/or FFP. All patients were given with Solu - Medrol in ECC prime. The perfusion flow range 20 -200 mL/（ kg · min） and the mean arterial pressure range 25 - 40 mmHg were controlled during ECC. The histidine - tryptophan - ketoglutarate solution at 25 - 50 mL/kg was ap- plied for myocardial protection. Ultrafiltration technique was used during ECC. Results The ECC duration was 13 - 529 （89.42 ± 57.50） min, and the aortic cross clamp duration was 0 -218 （44. 27 ± 27.99 ） rain. Twenty -four infants were dead. Conclusion Reasonable priming, accurate myocardial protection, effective perfusion flow, and ultrafiltration technique, were effective in ECC of LBWIs.

关 键 词：体外循环 低体重 婴幼儿 先天性心脏病 

分 类 号：R726.542[医药卫生—儿科]