无名动脉插管顺行脑灌注在婴幼儿复杂心脏手术中的应用——单中心回顾性研究  

Innominate artery cannulation for antegrade cerebral perfusion in neonates for complex cardiac surgery-a single centreretrospective study

作　　者：钟慧[1] 王秀华[1] 叶明[1] 贾兵[1] 

机构地区：[1]复旦大学附属儿科医院心血管中心,上海201102

出　　处：《中国体外循环杂志》2015年第3期150-153,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的评估直接无名动脉插管顺行脑灌注在婴幼儿复杂心脏手术中应用的参数及其安全性。方法收集2011年1月至2014年7月24名接受顺行脑灌注的婴幼儿临床资料。该组患者全部采用双心室修补,重建主动脉弓和纠正伴发的其它心内畸形。体外循环采用深低温停循环结合直接无名动脉插管行脑顺行灌注方法（ACP）,脑灌注流量参数范围内是25-50 ml/（kg·min）,右侧桡动脉压力控制在25-40 mm Hg,体温控制在18-20℃并评估患儿围术期神经系统并发症的情况。结果围术期有2例手术病例死亡,1例双心室修补的患儿死于严重心衰,1例死于全身严重感染。在22例存活病例中有2例出现神经系统异常,出院时诊断为肌张力过低,其中一例在心脏监护室发生过心脏骤停,而另一例术前经超声证实存在大脑基部神经节钙化。其余22/24例患儿出院时神经系统评估正常。结论在婴幼儿主动脉弓重建手术中采用无名动脉插管行脑顺行灌注技术是安全可靠的。Objective To evaluate the measurements and safety of direction cannulation of the innominate artery for antegrade cerebral perfusion（ACP） in neonates for complex cardiac surgery.Methods Clinical data of 24 consecutive neonates who underwent ACP from January 20 f f to July 2014 were collected.All patients underwent double ventricular repair,reconstruction of the aortic arch and concomitant repair of the other defects.The technique of deep hypothermic circuit arrest（DHCA） and ACP by the innominate artery cannulation were utilized during the period of cardiopulmonary bypass.ACP flow varied between 25ml/Kg/Min to 50ml/Kg/Min,the right radial artery pressure between 25 mmHg to 40 mmHg,the body temperature between 18℃ to 20℃ The postoperative neurologic complications were analyzed.Results There were 2 operative deaths（8.3%）.One patientdied of postoperative heart failure and one died of severe sepsis.Of the 22 surviving patients,two had neurological defects.Two patients were discharged with diagnosis of hypotonia,one experienced cardiac arrest in the intensive unit and one had calcification of the basal ganglia on ultrasonography.Twenty survivals had normal neurologic function on discharge.Conclusion Innominate Artery Cannulation for antegrade cerebral perfusion is a safe and reliable technique during neonatal aortic arch reconstruction.

关 键 词：无名动脉 插管 顺行脑灌注 复杂心脏手术 婴幼儿 

分 类 号：R726.5[医药卫生—儿科]