选择性脑灌注在新生儿及婴幼儿大血管手术中的应用

目的 探讨新生儿及婴幼儿大血管手术深低温停循环中,结合应用选择性脑灌注(selective cerebral perfusion,SCP)对脑的保护安全性和可行性.方法 2009年4月至2011年5月行一期主动脉弓部重建的患儿18例(新生儿6例,婴幼儿12例),主动脉弓离断8例及主动脉弓缩窄10例,均合并室间隔缺损,其中合并动脉导管未闭12例,合并卵圆孔未闭14例.采用复方电解质注射溶液、红细胞、血浆、20%人血白蛋白、甲基强的松龙等预充,血液稀释后红细胞压积0.25～0.30.结果 所有患儿心脏均自动复跳,自动复跳率为100%,无恶性心律失常;体外循环(cardiopulmonary bypass,CPB)时间103～201 min(141.16±28.15)min];主动脉阻断时间(67.94±10.61)min;SCP时间(38.11±10.81)min;SCP灌注流量(20.31±9.21)ml/(kg·min);清醒时间(4.19±1.68)h;机械通气时间(63.22±27.66)h;ICU滞留时间(5.8±2.17)d;住院时间(20.33±6.06)d;CPB中尿量(86.94±59.43)ml;超滤液总量(1053.88±431.04)ml;改良超滤出液量(143.05±23.83)ml.所有患儿术后无神经系统并发症,均痊愈出院.结论 SCP在新生儿及婴幼儿大血管手术中是可行且安全的脑保护方法.

Application of selective cerebral perfusion in neonates and infants undergoing great artery operations

To summarize and approach the security and feasibility as well as the cerebral protective effect of selective cerebral perfusion（SCP）technique during one stage repair of aortic arch using deep hypothermia circulatory arrest（DHCA）in neonates and infants.Eighteen patients undergoing one stage repair of aortic arch with DHCA and SCP were included between April 2009 and May 2011,in which 6 were neonates and 12 were infants.Ten of them were male and eight of them were female.The abnormality was composed of eight interruption of aortic arch and 10 aortic arch coarctation.Ventricular septal defect was found in all cases,patent ductus arteriosus was found in 12 cases,and patent foramen ovale was found in 14 cases.The priming solution included compound electrolytes injection solution,red blood cell,plasma,20%human albumin,and methylprednisolone to keep the haematocrit between 0.20 and 0.30.The heartbeat recovered spontaneously in all patients after the remove of the cross clamp.The spontaneous rebeating rate was 100%,without malignant arrhythmia.The mean cardiopulmonary bypass（CPB）time was（141.16 ± 28.15）minutes.The aortic cross clamping time was（67.94 ± 10.61）minutes.The mean SCP time was（38.11 ± 10.81）minutes.The SCP blood flow rate was（20.31 ± 9.21）ml/kg·minutes.The patients waked from anesthesia in（4.19 ± 1.68）hours.The postoperative average mechanical ventilation time was（63.22 ± 27.66）hours.The duration of ICU stay was（5.8 ± 2.17）days.The hospitalization time was（20.33 ± 6.06）day.The urine volume during CPB procedure was（86.94 ± 59.43）ml.The conventional ultrafiltration volume was（1053.88 ± 431.04）ml.The modified ultrafiltration volume was（143.05 ± 23.83）ml.All patients recovered well without systematic complications.SCP is a feasible and effective technique during great artery operation in neonates and infants.