153例10公斤以下婴幼儿心脏直视手术的体外循环管理

目的总结10公斤以下婴幼儿心脏直视手术的体外循环管理。方法 2006年12月-2011年7月共对153例10公斤以下婴幼儿在体外循环下实施例心脏直视手术,男82例,女71例,年龄为5个月-5岁,平均（20.0±8.4）个月,其中5-12个月31例,13-24个月82例,25-36个月39例,37-60个月1例;体重4-10 kg,平均（8.9±1.3）kg。69例使用膜肺,84例使用西京87型（小号）鼓泡式氧合器;19例采用心脏不停跳下手术,其余均阻断升主动脉,灌注冷晶体心脏停搏液,浅或中低温高流量灌注。结果体外循环时间为18-166（57.5）min,主动脉阻断时间为8-123（39）min,开放主动脉后148例患儿心脏自动复跳,自动复跳率为97%,辅助时间为4-60（16）min。术后患儿死亡3例,死亡率为2%,死亡原因2例为严重低心排,1例为突然心脏骤停,抢救无效临床死亡。结论根据婴幼儿的体重、病情及手术操作难易程度选用膜肺或鼓泡肺,尽量减少预充晶体量,提高胶体预充量,采用高流量灌注,通过给予速尿、超滤、加入白蛋白提高胶体渗透压,排除体内多余水分及良好的心肌保护、肺保护、脑保护有利于患儿术后的恢复。

Extracorporeal circulation of open heart surgery in infants with 153 cases weithed below 10kg management

Objective To summarize the extracorporeal circulation(ECC) management in infants weighted below 10 kg with open heart surgery.Methods 153 cases weighted below 10 kg with open heart surgery from December 2006 to July 2011,Male 82 cases,female 71 cases,age 5 months-5 years on average(20±8.4) months,5-12 months 31 cases,13-24 months 82 cases,25-36 months 39 cases,37-60 months 1 case;weight was 4-10 kg,the average was(20 ±1.3) kg,69 cases with membrane oxygenator,84 cases with Xijing 87(small) bubbling oxygenator;19 patients with beating heart surgery,the rest were aortic cross clamp(ACC),infusion of cold crystalloid cardioplegia,mild or moderate low temperature and high flow in the perfusion.Results The mean ECC times were 18-166(57.5) min,aortic cross-clamping times were 8-123(39) min,with the heartbeat recovered spontaneously in 148 cases after aortic clamping release(CCR),automatic beating rate was 97%,support time was 4-60(16) min.3 infants died after operation,the mortality rate of 2%,causes of death in 2 cases of severe low cardiac output,1 case died of sudden cardiac arrest.Conclusion According to infant weight,condition and ease of use surgical operation bubbling oxygenator or membrane oxygenator to minimize the amount of priming,high flow perfusion,by giving Lasix,ultrafiltration,adding albumin colloid to improve osmotic pressure avoidance of fluid retention and favourable myocardial and lung also cerebral preservation,will helpful postoperative recovery