40例儿童法洛四联症根治术的体外循环管理

目的探讨儿童法洛四联症(TOF)的体外循环(CPB)管理方法。方法回顾我科自2003年3月至2004年11月进行的40例儿童TOF根治手术的CPB情况,包括血液稀释、灌注方式、心脑肺保护等。结果CPB时间50～178(110.9±26.5)分钟(min),主动脉阻断(ACC)时间36～151(79.6±23.6)min.主动脉开放(CCR)后38例心脏自动复跳,自动复跳率95%。常规应用多巴胺支持撤机,停机顺利。38例采用中低温中低流量灌注,2例采用深低温低流量CPB,CPB中尿量50～1000(324.7±268.9)毫升(ml)。全部应用改良超滤(MUF)7～15(11.2±2.2)min,滤出液500～1000(651.4±110.3)ml,超滤后红细胞压积(HCT)升至35%～40(36.6±1.4)%。术后呼吸机支持时间2.5±99.8(12.4±25.5)小时(h),重症监护室(ICU)停留时间1～8(2.2±0.5)天(d),无死亡病例。结论儿童TOF手术的CPB管理是手术成功的一个重要方面,我们认为:应采用适中的血液稀释和胶体液预充、选择与外科手术相配合的灌注方式、应用MUF、注意术中心脑肺保护。

The management of cardiopulmonary bypass on children with tetralogy of Fallot

Objective To retrospect the management of cardiopulmonary bypass(CPB) on children with tetralogy of Fallot(TOF).Methods 40 children with TOFunderment corrective procedure .This article reviews the methods of CPB including priming,hemodilution,perfusion pattern and myocardium,brain and lung protection.Results The total CPB time,aortic cross clamp(ACC) time was 50～178(110.9±26.5) min,and 36～151(79.6±23.6) min respectively.After cross-clamping release(CCR),38 cases returned spontaneously,the rate of heart rebeating 95%.All cases weaned from CPB with the support of the Dopamine.38 adopted moderate hypothermia moderate flow perfusion,and another 2 underwent deep hypothermia low flow perfusion(DHLF).The urine during CPB was 50～1 000(324.7±268.9) ml.The modified uitrafiltration was applied to all patients,and liquid 500～1 000(651.4±110.3) ml removed .The hematocrit(HCT) at the end of operation was 35～40 (36.6±1.4)%.The ventilator time and ICU stay was 2.5～99.8(12.4±25.5)hours and 1～8(2.2±0.5) days respectively.All cases survived.Conclusion The management of CPB on children with TOF is an important aspect to successful operation.We emphasize moderate hemmodilution,colloid priming,selecting corresponding perfusion pattern to surgical procedure,applying MUF and giving more attention to intro-operative heart,brain and lung protection.