改良扩大Morrow手术治疗儿童肥厚型梗阻性心肌病的体外循环管理  

Extracorporeal circulation management for modified Morrow surgery in children with hypertrophic obstructive cardiomyopathy

作　　者：王会颖[1] 冯正义[1] 赵明霞[1] 张旌[2] 闫军[2] 李守军[2] 刘晋萍[1] Wang Huiying;Feng Zhengyi;Zhao Mingxia;Zhang Jing;Yan Jun;Li Shoujun;Liu Jinping(Department of Cardiopulmonary Bypass,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院体外循环中心,北京100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院小儿心脏外科中心,北京100037

出　　处：《中国体外循环杂志》2020年第1期8-11,20,共5页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金(81670375)

摘　　要：目的探讨肥厚型梗阻性心肌病(HOCM)患儿行改良扩大Morrow手术围术期的特点及体外循环管理方法。方法回顾性分析2013年1月至2018年12月在本院接受改良扩大Morrow手术的49例HOCM患儿围术期资料及体外循环管理要点。结果 49例患儿,年龄(5.3±3.4)岁,体重(17.9±8.0) kg,转机时间(115.7±47.0) min,阻断时间(74.1±27.1) min,辅助时间(31.83±34.67) min。使用HTK液进行心肌保护的患者41例(83.7%),改良St. Thomas液患者8例(16.3%),自动复跳率32例(65.3%)。患儿术后气管插管时间17(8,22) h,ICU时间2(1,3) d。其中1例低心排患儿转中由体外循环直接转为体外膜氧合(ECMO),辅助时间126 h后撤机,存活出院;2例术后因肺部感染死亡;4例安装永久起搏器。结论改良扩大Morrow手术是治疗儿童HOCM的有效治疗方法,体外循环过程足量的心肌灌注,充分的辅助时间,选择合适的心脏停搏液是围术期心肌保护的重点。对于术后低心排血量综合征患儿积极的ECMO辅助是有效的治疗方法。Objective To investigate the characteristics of perioperative patients with modified and expanded Morrow surgery and the management of cardiopulmonary bypass in children with hypertrophic obstructive cardiomyopathy. Methods A retrospective analysis of the perioperative data of 49 children with HOCM who underwent modified Morrow procedure in our hospital from January 2013 to December 2018. Results For the forty-nine patients,the average age was 5.3±3.4 years and the average body weight was 17.9±8.0 kg. The average CPB time was 115.7±47.0 min,the cross-clamping time was 74.1±27.1 min and the assisted bypass time was 31.83±34.67 min. Forty-one patients( 83.7%) underwent myocardial protection with HTK fluid,8 patients( 16. 3%) used modified St.Thomas,and automatic re-beating rate was 65.3%. The postoperative mechanical ventilation time was 17( 8,22) h and the ICU time was 2( 1,3) days. One patient with low cardiac output was transferred to ECMO for 126 hours,and then he was cured and discharged.Two patients died of pulmonary infection after operation,and 4 patients were equipped with permanent pacemakers. Conclusion The modified and extended Morrow procedure is an effective treatment for pediatric patients with HOCM. Sufficient amount of myocardial perfusion during cardiopulmonary bypass,adequate assisted bypass time,and selection of appropriate cardioplegia are the focus of perioperative myocardial protection. Active ECMO assistance in patients with postoperative low cardiac output syndrome is an effective treatment.

关 键 词：肥厚型梗阻性心肌病 体外循环 儿童 改良扩大Morrow手术 心肌保护 心脏停搏液 心肌灌注 体外膜氧合 

分 类 号：R54[医药卫生—心血管疾病]