微量晶体心肌保护灌注法在婴幼儿体外循环中的应用

目的观察在婴幼儿体外循环(CPB)中采用自制微量晶体心肌保护灌注方法的临床效果。方法选择10 kg以下择期在CPB下行室间隔缺损修补术的患儿100例,随机分为试验组和对照组,每组各50例。心肌保护均采用顺行灌注高K+含血停搏液,试验组采用微量晶体灌注方法,对照组采用传统储血罐灌注方法。分别于麻醉诱导后(T1)、CPB 20 min(T2)、主动脉开放后(T3)、手术结束即刻(T4)检测动脉血气的K+离子浓度、红细胞比容(Hct)、乳酸(Lac)并进行比较,比较患儿术前和术后一般情况、左室射血分数(EF)、CPB时间、主动脉阻断时间、心脏复苏、术中超滤量、CPB预充总量、围术期用血量,肌酸激酶(CK)和肌酸激酶同工酶(CKMB)等数据。结果 1两组患儿术前一般情况、术前和术后EF值、CPB时间、阻断时间、心脏复苏率、术中超滤量无统计学差异(P>0.05)。2T1、T2、T3、T4的动脉血气K+、Hct、Lac均无统计学差异(P>0.05)。3两组患儿CK、CKMB在术前、术后1天、术后3天各时间点组间比较均无统计学差异(P>0.05),但CK、CKMB在术后1天明显升高,与术前比较有显著差异(P<0.01),术后3天较术后1天明显下降(P<0.01),但仍高于术前水平(P<0.05)。4试验组较对照组CPB预充总量和围术期用血量均明显减少(P<0.05)。结论在婴幼儿CPB中的心肌保护使用微量晶体灌注方法能获得与储血罐灌注法相同的效果,但预充液总量和围术期用血量明显减少。

The application of micro pump crystal solution perfusion device in infants' con-genital heart diseases with cardiopulmonary bypass

Objective To observe the clinical effect of myocardial protection using micro pump crystal solution perfusion device in infants＇ congenital heart diseases with cardiopulmonary bypass（ CPB）. Methods Form Jun. 2010 to Oct. 2012,100 infants（ body weight 10 kg） with ventricular septal defect（ VSD） scheduled for cardiac surgery with CPB were enrolled and randomized into experimental（ E） group and control（ C） group,50 cases each. After aortic cross clamping,the way of antegrade cardioplegia perfusion with hyperpotassemia（ potassium 20 mmol /L） was chosen as myocardial protection method for all infants. Micro pump crystal solution perfusion device was used in E group and traditional blood reservoir perfusion device was used in C group. The concentrations of potassium,hematocrit（ Hct）,lactate（ Lac） from the arterial blood gas were compared between two groups at following time points： preoperation（ T1）,20 min after CPB（ T2）,aortic declamping（ T3）,leaving operating room（ T4）. The time of CPB and aortic cross clamping,cardiac resuscitation rate,filter fluid during CPB,total volume of CPB priming and banked red blood cell（ BRBC） transfusion perioperative,left ventricle ejection fraction（ EF） and blood concentration of creatine kinase（ CK）,creatine kinase MB（ CKMB） before and after operation of two groups were collected. Results 1.There were no significant differences in preoperative and postoperative EF,time of CPB and aortic cross clamping,cardiac resuscitation rate between two groups（ P 〉0.05）. 2. There were no significant differences in the concentrations of potassium,hematocrit（ Hct）,lactate（ Lac） from the arterial blood gas between two groups in T1,T2,T3,T4（ P 〉0.05）. 3. The concentration of CK and CKMB on the preoperative day,1 day and 3 day postoperatively between two groups had no significant differences（ P 〉0.05）,which was increased significantly on the 1 day postoperatively（ P 〉0.01）and recovered on 3 day postoperati