婴幼儿心内直视手术后容量平衡的管理  

THE POST-OPERATION VOLUME MANAGEMENT OF PEDIATRIC CARDIAC SURGERY WITH CARDIOPULMONARY BYPASS

作　　者：于军[1] 邵金霞 郭少先[2] 张海涛[2] 李颠远[2] 

机构地区：[1]海南心血管病医院,海口570208 [2]北京阜外心血管病医院

出　　处：《海南医学》2001年第5期8-9,29,共3页Hainan Medical Journal

摘　　要：目的　动态观察婴幼儿体外循环下心内直视手术中及手术后早期容量的变化 ,监测及指导手术后合理的补充容量。方法　回顾性研究婴幼儿体外循环下心内直视手术 176例手术中及手术后容量的动态变化 ,测量体外循环预充量 ,手术中入量 ,出量 ;手术后出入量及相互之间的关系。结果　预充总量 837.7± 6 7.85 m l/例 ,平均每公斤体重预充量 80 .0 8ml,预充库血量占病人血容量 5 0 .2 7% ,预充库血量占预充总量的 5 0 .37% ,预充液晶胶比 0 .6 83± 0 .2 42 ,手术中入量 6 7.5 6± 38.19ml/kg,体外循环结束时余血量 46 4.7± 138.9nl/例 ,手术后麻醉及监护室(ICU )内使用机器余血 2 33.49± 136 .79ml/例。手术后第一天入量 <出量 2 0 ml/kg,尿量 >入量 10 m l/kg,术后第二天入量 <出量 7ml/kg,尿量 >入量 3m l/kg,术后第三天入量 <出量 4m l/kg,尿量 >入量 1ml/kg,术后第四天入量<出量 1ml/kg,尿量 >入量 1ml/kg,结论　 <10 kg体重婴幼儿预充液体总量尽可能减少并以全血加新鲜冰冻血浆为主 ,手术后早期在保证循环稳定的前提下欠量补液 。Objective To monitor and indicate the volume management of post-operation reasonably through observing the volume changes after and during pediatric cardiac surgery.Methods 176 infants undergoing cardiac surgery were retrospective observed with the volume changes during and after operations,and also were evaluated changes during and after operations,and also were evaluated the relationship between the inputs and outputs after surgery by measuring the total priming,the inputs and outputs during and after operations.Results During the cardiopulmonary bypass,the total priming was 837.7±67.85ml/case(80.08ml/kg),the banked blood in the prim ing was 50.27 percent of patients' whole blood volume and 50.37 percent of total priming,the crystalloid-colloid ratio was 0.683±0.242,the total inputs in CPB was 67.56±38.198ml/kg,the rest blood volume in the heart-lung machine was 464.7±138.9ml/case and 233.49±136.79ml/case of them were used in anesthesia and ICU.The inputs in the first day of post-operation was less than ortputs 20ml/kg,Urine outputs was more than inputs 10ml/kg.The inputs in the second day of post-operation was less than outputs 7ml/kg,Urine ourputs was more than inputs 3ml/kg.The inputs in the third day of post-operation was less than outputs 4ml/kg,Urine outputs was more than inputs 1ml/kg.The inputs in the fourth day of post-operation was less than outputs 1ml/kg,Urine outputs was more than inputs 1ml/kg.Conclusion The priming in CPB of the infant who is less than 10kg should be reduced as possible and subjcted with the whole blood and fresh frozen plasma.In the early period of post-operation,the infants should be supplied with the owed volume and diuresis on time under the stable of hemodyamics.

关 键 词：婴幼儿 心内直视手术 容量 体外循环 补液 气管插管 

分 类 号：R726.542[医药卫生—儿科]