体质量小于5kg婴儿心内直视手术的体外循环管理

目的 总结体质量＜5 kg婴儿心内直视手术体外循环(CPB)的管理经验.方法 回顾性分析行心内直视手术的体质量＜5 kg 婴儿168例的临床资料.男104例,女64例;年龄3 d～6个月;体质量2～5 kg其中常温5例,浅低温88例,中低温52例,深低温低流量23例,深低温停循环选择性脑灌注10例.深低温患儿应用pH稳态、甲泼尼龙、甘露醇.CPB中监测ECG、平均动脉压、经皮血氧饱和度、鼻咽温、肛温、尿量和中心静脉压.结果 CPB时间为18～155(45.26±23.36) min;主动脉阻断时间为18～85(33.22±20.25) min;自动复跳率为98.2%.患儿均顺利脱离CPB.15例出现并发症,包括低心排综合征、低氧血症各3例,延迟关胸2例,肺不张、气胸、肾功能不全、纵隔感染、消化道出血各1例,再次开胸止血及残余分流各1例.术后死亡4例,病死率为2.34%,主要死亡原因为心肺功能衰竭.结论 CPB中应用个体化管理和采用综合措施是婴儿心内直视手术成功的保障.

Management of Cardiopulmonary Bypass in Infants Less Than 5kg with Open Heart Operation

Objective To summarize the experience of cardiopulmonary bypass(CPB)management of infants whose weight were less than 5 kg.Methods A total of 168 infants whose weight were less than 5 kg were reviewed,104 cases were male,64 cases were female.Five cases received common temperature,88 cases with mild hypothermia,52 cases with moderate hypothermia,23 with deep hypothermia low flow,10 cases with deep hypothermia circulatory arrest and selection cerebral perfusion.Deep hypothermia were managed by pH-stat blood gas and use methylprednisolone,mannitol.During CPB,mean arterial blood pressure,heart rate,venous admixture saturation of blood oxygen,urinary volume,nasal pharyn temperature,rectal temperature and central venous pressure were monitored.Results The mean CPB time was 18-155(45.26±23.36) min,and aortic cross clamping time was 18-85(33.22±20.25) min.The incidence of automatic heart resuscitation was 98.2%.All the cases were weaned from CPB successfully.The postoperative complications occurred in 15 cases,included low cardiac output syndrome in 3 cases,hypoxemia in 3 cases,delay close sternum in 2 cases,pulmonary atelectasis in 1 case,aeropleura in 1 case,renal inadequacy in 1 case,mediastina infection in 1 case,alimentary tract hemorrhage in 1 case;again open sternum for bleeding in 1 case,residual shunt in 1 case.Four cases died and the mortality was 2.34%.The main death cause was the failure of heart function and pulmonary function.Conclusion It is important to intensify combination measures and individuation managements of CPB for ensuring surgical safety.