儿童心脏移植的体外循环管理  

Experiences of cardiopulmonary bypass for children heart transplantation

作　　者：李平[1] 赵阳[1] 董念国[1] 高思海[2] 

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 [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：《中国体外循环杂志》2015年第4期219-222,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的总结20例儿童心脏移植的体外循环管理经验。方法 2008年9月至2015年3月武汉协和医院共行20例儿童心脏移植,其中男11例,女9例,扩张性心肌病为移植主要病因,儿童平均年龄（10.76±5.97）岁,最小年龄3个月;平均体重（33.23±18.51）kg,最小体重5.2 kg;供心保护采用康斯特保护液（HTK液）,经主动脉根部灌注冷HTK心脏停搏液,快速取下心脏,置于4℃HTK液中低温保存。供体/受体体重比（1.62±0.62）。采用浅低温、轻中度血液稀释、中高流量体外循环灌注方法。术中连续监测血气和电解质,常规使用超滤技术和白蛋白,转中维持MAP 55~65 mm Hg,SvO2〉70%,Hct 0.24~0.27,停机改良超滤,维持Hct 0.32~0.40。结果除2例患儿心脏移植术后出现低心排而行体外膜肺氧合（ECMO）辅助支持外,余18例患儿术中平稳,自动复跳,均顺利脱离体外循环。所有患儿均痊愈出院,取得满意手术疗效。供心冷缺血时间平均（228.69±144.97）min,体外循环时间平均（119.56±42.32）min,辅助时间平均（72.25±35.78）min。结论良好的心肌保护,维持有效胶体渗透压及超滤排出体内多余水分是儿童心脏移植体外循环管理的关键,对于脱机困难者或术后低心排者,及时使用ECMO,能而有效提高心脏移植围术期抢救成功率。Objective To summarize the experiences of cardiopulmonary bypass（CPB） in 20 cases of pediatric heart trans-plantation.Methods Twentycases of pediatric heart transplantation were performed in wuhan Union hospital from September 2008 toMarch 2015,including 11 male and 9 female.The main cause of transplantation was dilated cardiomyopathy. The average age was 10.76±5.97 years old with the minimum age of 3 months.The average weight was 33.23±18.51 kg, the minimum body weight being 5.2 kg.Cardioplegia of Histidin-Tryptophan-Ketoglutarat（HTK） was delivered for the protection of the donor hearts. The removed hearts wereinfused with and stored in 4℃ HTK solution. Donor/ recipient body weight ratio was 1.62±0.62. Mild hypothermia,moderate hemodilu-tion and high flow rate perfusion were used during CPB. Blood gas and electrolyte were monitored continuously,and the application of ul-trafiltration and albumin before termination of bypass were essential tomaintain a MAP of 55 to 65 mm Hg, SvO2〉70%, Hct 0.24-0.27 during the CPB, and Hct 0.32-0.40 after modified ultrafiltration.Results Except 2 cases of heart transplantation were supported byECMO due to postoperative low cardiac output, 18 cases achieved rebeatingautomatically, and successfully weaned from cardiopulmo-nary bypass. All patients obtainedsatisfactory curative effect. The CPB time was 119.56±42.32 min, and cold ischemia time was 228.69±144.97 min,andparallel bypass time was 72.25±35.78 min.Conclusion Effective myocardial protection to the donor heart,effectivecolloid osmotic pressure maintainance and application of ultrafiltration and albumin are essential to guarantee the success of CPB man-agement. The use of ECMO as a timely manner for patients who cannot wean from CPB during operation or with postoperative low cardi-ac output can effectively improve the success rate of pediatric orthotopic heart transplantation.

关 键 词：儿童 心脏移植 体外循环 

分 类 号：R726.5[医药卫生—儿科]