改良超滤致循环系统进气原因分析与应对策略  

Etiology analysis and management strategies for air embolism in circulatory systems during modified ultrafiltration

作　　者：郭铮[1] 张蔚[1] 沈佳[1] 姜磊[1] 黄坚鹄 王伟[1] Guo Zheng;Zhang Wei;Shen Jia;Jiang Lei;Huang Jianhu;Wang Wei(Department of Pediatric and Thoracic Cardiovascular Surgery,Shanghai Children’s Medical Center,Shanghai Jiao Tong University,School of Medicine,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科体外循环科,上海200127

出　　处：《中国体外循环杂志》2025年第2期122-126,共5页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金(82470417)。

摘　　要：目的分析改良超滤(MUF)致循环系统进气的原因,并探讨预防措施以及处理策略。方法回顾性总结上海儿童医学中心近12年心肺转流(CPB)过程中发生的MUF致循环系统进气事件,并对其发生原因、处理方法、预后情况等予以分析。结果2013年1月至2024年8月,上海儿童医学中心共计开展CPB手术34519例,其中MUF致循环系统进气事件共计18例(0.05%),人为因素和技术因素各9例。人为因素中,灌注师操作失误8例,外科医生操作失误1例。技术因素9例均为动脉置管时插管开口靠近动脉管壁,MUF时动脉插管开口吸住动脉管壁所致。18例事件中,3例患儿出现术后短期神经系统并发症,1例死亡,其余无明显后遗症。结论MUF致循环系统进气主要是人为疏忽和主动脉插管开口吸住动脉管壁所致。加强外科置管和意外处理能力培训,术中做好核查和监测,保持术者和灌注师间良好沟通,故障设备及时报修,可降低进气事件风险,积极和正确的处理策略可减少并发症的发生。Objective To investigate the etiology of air embolism in circulatory systems during modified ultrafiltration(MUF)and to propose prevention measures and management strategies.Methods We conducted a retrospective analysis of air embolism events during cardiopulmonary bypass(CPB)at Shanghai Children’s Medical Center over a 12-year period.Data on causative factors,management approaches,and clinical outcomes were systematically evaluated.Results Among 34,519 CPB procedures performed between January 2013 and August 2024,18 cases(0.05%)of air embolism during MUF were identified.Human factors accounted for 9 cases(8 perfusionist errors,1 surgical error),while technical factors comprised the remaining 9 cases,all attributed to arterial cannula orifice proximity to the vessel wall,leading to wall suction during MUF.Clinical outcomes included transient neurological complications in 3 patients and 1 mortality,with no significant sequelae in the remaining cases.Conclusion Air embolism during MUF primarily results from human error and arterial wall suction by cannula orifices.Implementation of comprehensive training programs for cannulation and emergency management,rigorous intraoperative verification protocols,enhanced surgeon-perfusionist communication,and timely equipment maintenance can significantly reduce air embolism risks.Prompt and appropriate management strategies are crucial for minimizing complications.

关 键 词：体外循环 改良超滤 不良事件 心脏手术 

分 类 号：R726.1[医药卫生—儿科]