小儿先天性心脏病并肺动脉高压的体外循环管理

目的 总结先天性心脏病合并肺动脉高压的患儿在心内直视纠治术中体外循环(CPB)的管理。方法回顾性总结2000～2002年100例小儿先心病合并肺动脉高压的CPB手术，其中轻度肺动脉高压50例，中度38例，重度12例。CPB采用浅低温、中度血液稀释、高流量。转流中常规使用硝普钠，部分婴幼儿使用超滤技术。结果 CPB22～161min，阻断主动脉10～112min，血气分析、电解质监测正常。全部患儿心脏自动复苏，无死亡和并发症。结论 先心病合并肺高压CPB转流中，应特别注意心肌保护、肺保护、酸碱平衡、电解质紊乱的纠正和扩血管药物以及超滤技术的应用。

Extracorporeal Circulation Management In Children with Congenital Heart Disease and Pulmonary Hypertension

OBJECTIVE To Summary extracorporeal circulation management of congenital heart disease with pulmonary hypertension in children.METHODS 100 cases with congenital heart disease and pulmonary hypertension extracorporeal circulation operations were performed from 2000 to 2002 were retrospective summary , among them 50 cases suffered with mild HP, 38 cases with moderate HP, 12 cases with severe HP. All adopted mild hypothermia, moderate hemodilution, high flow. Sodium nitroprusside was used routinely. Ultrafiltration was used in portion of infants.RESULTS The time of extracorporeal circulationi was from 22 minutes to 161minutes, aorta crass clamping from 10 to 112 minutes. Monitoring blood gas analysis and electrolytes within normal rang, autoresuscitation occured in every heart , no death and complication . CONCLUSION Myocardial preservation, pulmonary protection, acid-base balance and electrolyte disturbance, ultrafiltration and vasodilatoin should be attempted during extracorporeal circulation.