应用心脑联合灌注策略改善复杂主动脉畸形患儿术后早期预后的临床研究  

Clinical study on early postoperative prognosis of patients with complex aortic malformation with myocardial and cerebral perfusion strategy

作　　者：赵聪聪[1] 刘晋萍[1] 冯正义[1] 赵举[1] 胡金晓[1] 崔勇丽[1] 李守军[1] 闫军[1] 

机构地区：[1]北京协和医学院中国医学科学院阜外医院体外循环科,北京硕士研究生100037

出　　处：《中国体外循环杂志》2017年第1期13-17,共5页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金资助项目专项(81370351)

摘　　要：目的观察并比较心脑联合灌注和单纯区域性脑灌注在小儿复杂主动脉手术中的应用效果及对患儿早期预后的影响。方法回顾性分析2012年1月至2014年8月141例患有主动脉缩窄或主动脉弓中断合并心内畸形的小儿(1个月至94个月龄)术前、术中及术后的临床资料,根据体外循环灌注方式分为心脑联合灌注组(n=56)和单纯区域性脑灌注组(n=85),分析两组术中相关参数、术后生化指标、恢复情况及不良事件发生率等。结果心脑联合灌注组的转机时间、停循环时间、心脏停跳时间、手术时间、复温时间、呼吸机时间和住院时间均较单纯区域性脑灌注组明显缩短,并且心脑联合灌注组术后的天门冬氨酸转氨酶、直接胆红素、总胆红素和血尿素氮、肌酐等肝肾功能指标也较明显降低。结论在小儿主动脉弓手术中,选用心脑联合灌注的改良灌注策略可使患儿获得较好的预后,使患儿的住院时间和呼吸机支持时间缩短。Objective To investigate and evaluate the effect of cerebral and myocardial perfusion（ CMP） or only-regional cerebral perfusion（ only-RCP） in pediatric underwent complicated aortic surgery. Methods From 2012 to 2014,one hundred and fifty one children with coarctation of aorta（ Co A） or interrupted aortic arch combined with cardiac defects such as ventricular septal defect（ VSD） or atrial septal defect（ ASD） undergoing one-stage corrective surgery were included in this study. They were divided into two groups,CMP group（ n = 56） and only-RCP group（ n = 85）,based upon the cardiopulmonary bypass（ CPB） strategy. The surgery and CPB parameters,postoperative biochemical index,recovery situation,and postoperative complications of patients were recorded and compared between two groups. Results The bypass time,arrest time,operative time,cardiac ischemia time,the length of hospital stay and respiratory support time in CMP group were significantly shorter than those in only-RCP group. The level of biochemical index which can reflect the function of liver and kidney in CMP group was also lower than that in only-RCP group. Conclusion The modified perfusion strategy of CMP could provide better prognosis for children undergoing one-stage aortic arch surgery,and may reduce the length of hospital stay and the respiratory support time.

关 键 词：心脑灌注 区域性脑灌注 主动脉弓手术国 儿童 

分 类 号：R726.5[医药卫生—儿科]