67例婴儿心脏直视手术体外循环水电解质平衡的管理

６７例患先心病的婴儿在体外循环下接受心脏直视手术，稀释后血色素都维持于８０～１００ｇ／Ｌ，对大多数病例均采用中低温高流量灌注。按基本方法的差异分为Ａ（３０例）、Ｂ（３７例）两组。Ａ组中１２例因尿少在ＣＰＢ过程中加用了血液超滤；Ｂ组在ＣＰＢ过程中持续输注多巴胺３～４μｇ／ｋｇ／ｍｉｎ，该组机器中的余血７例经离心后将血球部份输回体内。两组在ＣＰＢ结束时，在平均尿量、血浆游离血红蛋白和动脉血乳酸含量及血色素尿均存在明显差异（ｐ＜０．０１或＜０．０５）。作者认为防止过度稀释，维持适当的胶体渗透压，在ＣＰＢ过程中充分的流量和应用低浓度多巴胺增加排尿及机器余血离心后输回，对减轻婴儿水负荷，维持水电解质平衡有较大的临床意义。

Management of Water and Electrolytes Balance during Cardiopulmnary Bypass in 67 Infants

Sixty-seven infants with congenital heart diseases underwent open heart surgery with CPB.Their Hb were 80～100g/L after hemodilution.In most cases, moderate hypothermia and high flow rate were employed.They were divided into Group A(n=30)and B(N=37)according to the different fundamental way.In Group A,12 cases needed hemofiltration during CPB because of oliguria.In Group B dopamine 3～4μg/kg/min was infused continuously during CPB.In 7 cases of this group,centrifuged residual blood in the heart-lung machine was transfused back to them.The results showed marked difference existed between the two groups on mean vol.of urine,plasma free Hb,arterial lactic acid and hemoglobinuria(p<0.01 or<0.05) at the termination of CPB.The results of Group B were better.The authors pointed out:It is of great benefit to keep water and electrolytes balance of infants,to prevent over dilution and maintain appropriate colloid pressure,to take the sufficient flow and low dose of dopamine during CPB and to use the centrifuged residual blood for infants.