8kg以下婴幼儿法洛四联症矫治术的体外循环管理  

Cardiopulmonary Bypass Management for Tetralogy of Fallot Infants Weighing Less Than 8 kg

作　　者：李平[1] 董念国[1] 杜心灵[1] 赵阳[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院心血管外科,武汉430022

出　　处：《中国胸心血管外科临床杂志》2014年第4期486-489,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金："十二五"国家科技支撑计划项目(2011BAI11B19)~~

摘　　要：目的总结8 kg以下婴幼儿法洛四联症（TOF）矫治术的体外循环管理经验。方法 2009年7月至2013年8月武汉协和医院共收治120例TOF患儿,男85例、女35例,年龄1~18个月,体重4~8 kg,均由超声心动图和心导管造影确诊,根据具体术式采用中度低温和深低温低流量灌注的体外循环方法,采用进口膜式氧合器,心肌保护液采用4∶1冷血心脏停搏液,术中持续零平衡超滤及术毕改良超滤。结果体外循环时间65~200（115.3±9.6）min,主动脉阻断时间40~110（60.3±10.2）min。112例采用中低温中低流量灌注,8例采用深低温低流量灌注,超滤滤出液（780.5±50.3）ml,改良超滤后红细胞压积升至0.35~0.40。主动脉开放后114例心脏自动复跳,自动复跳率95%。119例顺利停机,1例停机困难改用体外膜式氧合支持。术后呼吸机支持时间（26.5±14.5）h,术后住ICU时间（121.5±16.5）h,5例因低心排血量综合征死亡,余痊愈出院。结论采用适当的血液稀释和胶体液预充,选择与外科手术相配合的灌注方式,4∶1氧合血高钾心脏停搏液保护心肌,术中持续零平衡超滤及术毕改良超滤,维持合理红细胞压积和较高胶体渗透压,是提高婴幼儿TOF手术体外循环质量的关键。Objective To summarize cardiopulmonary bypass （ CPB ） management experience in tetralogy of Fallot （TOF） infants weighing less than 8 kg. Methods A total of 120 TOF infants weighing less than 8 kg received surgical repair in Wuhan Union Hospital from July 2009 to August 2013. There were 85 males and 35 females with their age of 1-18 months and body weight of 4-8 kg. The diagnosis of all the patients was made with echocardiography and diagnostic cardiac catheterization. Moderate hypothermia or profoundly hypothermic CPB with low-flow perfusion was used according to different surgical procedures. Imported membrane oxygenators and 4 ： 1 cold blood cardioplegia were used. Zero-balance ultrafiltration during CPB and modified ultrafiltration during rewarming were performed. Results CPB time was 65-200 （ 115.3 ± 9.6） minutes, and aortic cross-clamping time was 40-110 （60.3 ±10.2 ） minutes. A total of 112 patients received moderate hypothermia and low-or moderate-flow perfusion, and 8 patients received profound hypothermia and low-flow perfusion. Ultrafiltration volume was 780.5± 50.3 ml, and hematocrit （HCT） increased to 0.35-0.40 after modified ultrafiltra- tion. Heart beat was automatically recovered in 114 patients （ 95% ） after aortic unclamping. Weaning off CPB was successful in 119 patients, and 1 patient received extracorporeal membrane oxygenation because of difficult weaning from CPB. Postoperative mechanical ventilation time was 26.5±14.5 hours, and length of ICU stay was 121.5± 16.5 hours. Five patients died of low cardiac output syndrome, and the other 115 patients were discharged successfully. Conclusion Appropriate hemodilution and colloidal pump priming solutions, perfusion methods suitable with surgical procedures, 4 ： 1 cold blood- potassium cardioplegia, continuous zero-balance ultrafiltration during CPB and modified ultrafiltration during rewarming to maintain reasonable HCT and colloid osmotic pressure are all crucial factors in CPB management for surgical repair of T

关 键 词：体外循环 婴幼儿 法洛四联症 管理 

分 类 号：R726.5[医药卫生—儿科]