浅低温脑灌注在体外循环下小儿室间隔缺损修补术中的应用  

Application of mild hypothermia cerebral perfusion in treatment of pediatric ventricular septal defect repair under cardiopulmonary bypass

作　　者：王鸿[1] 汤蕙霞 刘杨[1] 陈凤 WANG Hong;TANG Hui-xia;LIU Yang;CHEN Feng(Department of Pediatric Surgery,Shengjing Hospital Affiliated to China Medical University,Shenyang Liaoning 110004,China)

机构地区：[1]中国医科大学附属盛京医院小儿外科,辽宁沈阳110004

出　　处：《局解手术学杂志》2020年第4期313-317,共5页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨浅低温脑灌注在体外循环下小儿室间隔缺损修补术中的应用效果。方法回顾性分析2017年2月至2018年7月我院收治的81例行体外循环下小儿室间隔缺损修补术患儿的临床资料,将术中采用浅低温脑灌注治疗的43例患儿设为浅低温组,术中采用中低温下脑灌注治疗的38例患儿设为中低温组。对比2组患儿术中最低鼻咽温度,术中最低直肠温度,术中体外循环时间,术中主动脉阻断时间,术后呼吸支持时间,术后心包和纵隔引流量,麻醉前(T0)、麻醉后10 min(T1)、手术开始后20 min(T2)、手术结束时(T3)血压(BP)及心率(HR)水平变化,术中室颤,术后低血压,术后心律失常及术后短暂性神经功能障碍发生率。结果浅低温组术中最低鼻咽温度、术中最低直肠温度均高于中低温组,差异有统计学意义(P<0.05),2组术中体外循环时间、术中主动脉阻断时间、术后呼吸支持时间、术后心包和纵隔引流量比较差异无统计学意义(P>0.05);各时刻2组间收缩压(SBP)、舒张压(DBP)、HR组间比较差异无统计学意义(P>0.05),且2组SBP、DBP和HR水平均先下降后升高,其中T1、T2、T3时刻BP和HR水平均明显低于T0时刻(P<0.05),T2时刻BP和HR水平均明显低于T1时刻(P<0.05),T3时刻BP和HR水平均明显高于T2时刻,差异均有统计学意义(P<0.05);浅低温组术后心律失常发生率与中低温组均相近,差异无统计学意义(P>0.05),浅低温组术中室颤、术后低血压、术后短暂性神经功能障碍发生率均显著低于中低温组,差异有统计学意义(P<0.05)。结论在体外循环下小儿室间隔缺损修补术中,应用浅低温脑灌注治疗可减少术中室颤、术后低血压及术后短暂性神经功能障碍。Objective To explore the effect and value of mild hypothermia cerebral perfusion in treatment of pediatric ventricular septal defect repair under cardiopulmonary bypass.Methods Clinical data of 81 pediatric patients who were admitted into our hospital from February 2017 to July 2018 and underwent ventricular septal defect repair under cardiopulmonary bypass were retrospectively analyzed.Among them,the 43 cases treated by mild hypothermia cerebral perfusion during operation were set as the mild hypothermia group,and the other 38 cases treated by moderate hypothermia cerebral perfusion during operation were set as the moderate hypothermia group.The lowest nasopharyngeal temperature during operation,minimum rectal temperature during operation,duration of cardiopulmonary bypass,duration of intraoperative aortic occlusion,time of postoperative respiratory support,volume of postoperative pericardial and mediastinal drainage,changes of blood pressure(BP)and heart rate(HR)[before anesthesia(T0),at 10 minutes after anesthesia(T1),at 20 minutes after operation(T2),and at the end of operation(T3)],incidence of intraoperative ventricular fibrillation,postoperative hypotension,postoperative arrhythmia and postoperative transient neurological dysfunction of the two groups were compared.Results The lowest nasopharyngeal temperature and minimum rectal temperature during operation in the mild hypothermia group were higher than those in the moderate hypothermia group,and the differences were statistically significant(P<0.05).There was no statistically significant difference in duration of cardiopulmonary bypass,duration of intraoperative aortic occlusion,time of postoperative respiratory support,volume of postoperative pericardial and mediastinal drainage between the two groups(P>0.05).There was no significant difference in systolic blood pressure(SBP),diastolic blood pressure(DBP),and HR between the two groups at any point-in-time(P>0.05).The levels of SBP,DBP and HR in the two groups decreased first and then increased.BP and HR

关 键 词：脑灌注 浅低温 中低温 小儿室间隔缺损 体外循环 室间隔缺损修补术 

分 类 号：R725.4[医药卫生—儿科] R541.1[医药卫生—临床医学]