心脏手术深低温低流量灌注不同血气管理对婴幼儿脑保护的影响  

Cerebral Protection of Blood Gas Management on Infants During Cardiac Operations in Deep Hypothermia Low Flow Perfusion

作　　者：王顺民[1] 苏肇伉[1] 朱德明[1] 徐志伟[1] 陈惠文[1] 

机构地区：[1]上海第二医科大学新华医院上海儿童医学中心心胸外科,上海200092

出　　处：《中国胸心血管外科临床杂志》2001年第2期73-75,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：卫生部科研基金资助项目! (96-2 -2 88)&&

摘　　要：目的　在深低温低流量灌注模式下 ,观察快速降温期应用不同稳态血气管理对婴幼儿脑功能的影响。方法　将 2 0例法洛四联症患者随机分为 p H稳态和 alpha稳态两组 ,并根据不同时间点、低流量和血气管理方案随机平均分层行析因分析。脑功能监测为 :生化指标、脑温、脑电图、智商等。　结果　应用 p H稳态的脑部温差较应用 al-pha稳态低 ;复温末 alpha稳态组中低流量 2 5 ml/ kg· min- 1 乳酸含量最高 ;术后 2 4小时 alpha稳态组中低流量 2 5 ml/kg· min- 1神经元特异性烯醇酶含量最高 ;术后 4天脑电图和术后 2个月智商两种稳态组间差别无显著性意义。　结论　深低温低流量灌注快速降温期应用 p H稳态进行血气管理可起到更好的脑保护作用。Objective To assess the effects of different blood gas management on infants'cerebral function during rapid cooling in deep hypothermia low flow cardiopulmonary bypass. Methods Twenty Tetralogy of Fallot cases were randomly divided into pH stat group and alpha stat group. Factorial analysis was done according to different phases, blood gas managements and low-flow strategies. Cerebral function assessment perioperation includes: biochemistry factors, brain temperature, electroencephalogram and intelligence quotient score. Results Brain temperature gradients in the group of pH stat were significantly lower in comparison with that in the group of alpha stat at the end of cooling. Lactate level is the highest in the group of alpha stat with low flow 25 ml/kg·min -1 at the end of rewarming. At 24-hour postoperations, Neuron specific enolase level was the highest in the group of alpha stat with low flow 25 ml/kg·min -1. No electroencephalogram and intelligence quotient score difference were found between two kinds of blood gas managements during postoperations' follow-up. Conclusion Better cerebral protection was provided by pH stat blood gas management during rapid cooling in deep hypothermia low flow perfusion.

关 键 词：深低温低流量 心脏手术 血气管理 脑保护 

分 类 号：R654.1[医药卫生—外科学]