低月龄及低体重患儿心脏手术的体外循环管理及预后

目的探讨低月龄、低体重患儿心脏手术的体外循环方法及管理策略。方法回顾性总结武警总医院2008年度至2012年度共297例月龄≤12月且体重≤10kg的先心病患儿行心内直视术的体外循环方法，分析围手术期并发症及死亡情况。结果体外循环时间16～122（57．4±13．9）min，主动脉阻断时间6～95（35．1±11．3）min，均采用改良超滤＋平衡超滤，围术期低心排综合征26例，急性呼吸窘迫综合征33例，难治性肺炎9例，肾功能衰竭5例，延迟关胸5例，围术期死亡5例。结论合理的预充和灌注，采用超滤并重视脏器的保护，是低月龄、低体重先天性心脏病患儿心脏手术的体外循环管理的合理策略，可以有效改善手术预后。

Extracorporeal circulation management and clinical prognosis in infants with congenital heart disease who have low months age and low body weight

Objective To review and analyze the extracorporeal circulation （ECC） mothod and clinical prognosis in the infants with congenital heart disease who have low months age and low body weight. Methods Summarize the ECC mothod and curative effect of 297 cases weighted below 10 kg and age below 12 months with congenital heart disease from January 2008 to December 2012 in our hospital. Results ECC time was 16- 122 （mean 57.4 ± 13.9） min. Aortic cross -clamp time was 6 -95 （mean 35.1 ± 11.3） min. Uhrafihration technique was applied for all cases. After operation, 26 infants suffered low cardiac output syndrome, 33 acute re- spiratory distress syndrome, 9 pneumonia, 5 renal failure, 5 delayed sternal closure and 5 infants died. Conclusion Selecting sutible priming fluid, applying ultrafiltration technique and strengthening organ protection are effective methods in ECC management of infants with congenital heart disease who have low months age and low body weight.