婴幼儿左向右分流型先天性心脏病合并重症肺炎的体外循环管理  

Extracorporeal circulation management for infants with left-to-right shunt congenital heart disease complicated by severe pneumonia

作　　者：张小贞 王树伟 刘洁 李刚 杭永斌 曹军营 周笠 徐彦斌 ZHANG Xiaozhen;WANG Shuwei;LIU Jie;LI Gang;HANG Yongbin;CAO Junying;ZHOU Li;XU Yanbin(Department of Cardiothoracic Surgery,No.153 Hospital of Liberation Army,Henan 450042,China)

机构地区：[1]郑州市解放军第一五三中心医院心脏外科,450042

出　　处：《国际心血管病杂志》2018年第4期233-235,共3页International Journal of Cardiovascular Disease

摘　　要：目的:探讨婴幼儿左向右分流型先天性心脏病合并重症肺炎的体外循环管理方法。方法:回顾性分析2013年5月至2017年6月我院收治的78例左向右分流型先天性心脏病合并重症肺炎患儿的临床资料,患者均接受急诊或亚急诊手术。术中应用浅低温、进口膜肺进行体外循环,经主动脉根部顺行灌注康斯特保护液(HTK液)进行心肌保护,术中应用常规超滤联合改良超滤技术。结果:体外循环时间为45~68 min,平均(50.24±12.45)min,主动脉阻断时间为10~60 min,平均(23.56±10.68)min。心脏自动复跳76例(97%)。转流结束后改良超滤时间为8~15 min,平均(10.45±3.24)min。术后死亡3例(3.8%)。结论:婴幼儿左向右分流型先天性心脏病合并重症肺炎常危及患儿生命,早期手术可获得理想的治疗效果。体外循环采用常规超滤联合改良超滤技术、合适的膜式氧合器、精确的预充及血液稀释、良好的心肌保护等措施是提高手术成功率的重要保障。Objective：To explore the extracorporeal circulation（ECC）management for infants with left-to-right shunt congenital heart disease complicated by severe pneumonia. Methods：A total of 78 in-patients with left-to-right shunt congenital heart disease complicated by severe pneumonia from May2013 to June 2017 were retrospectively analysed.All the patients received emergency or sub-emergency cardiac operations.The operations were performed with mild hypothermic extracorporeal circulation.Imported oxygenator and ultrafilter were used in all patients.The anterograde perfusion of histidinetryptophan-ketoglutarate solution through aortic root was applied for myocardial protection.Conventional and modified ultrafiltration were applied in all cases. Results：The cardiopulmonary bypass time was 45~68（50.24±12.45）min.The aorta crossclamping time was 10~60（23.56±10.68） min.Seventy-six patients had spontaneous cardiac resuscitation（97%）. The modified ultrafiltration time was 8~15（10.45±3.24）min.Three cases died after operation（3.8%）.Conclusions：Infants with left-to-right shunt congenital heart disease complicated by severe pneumonia are often life-threatening.Emergency or sub-emergency cardiac operations were effective for most of these patients.Combined conventional ultrafiltration with modified ultrafiltration,suitable oxygenation,reasonable priming perfusion and hemodilution,and excellent myocardial protection are important guarantees for improving success rate of operation.

关 键 词：体外循环 先天性心脏病 婴幼儿 重症肺炎 

分 类 号：R726.5[医药卫生—儿科]