婴儿法洛四联症体外循环管理探讨

目的 探讨婴儿法洛四联症体外循环(CPB)管理方法。方法 回顾我院自1997年7月开展婴儿法洛四联症心脏手术至2001年9月共28例的CPB情况,包括血液稀释、灌注方式、心脑肺保护等。结果 CPB时间50～406min,平均(112±66)min,主动脉阻断时间31～94min,平均(55±16)min。主动脉开放后28例心脏均自动复跳,自动复跳率100％。26例在多巴胺、肾上腺素支持下撤离CPB,2例经长时间辅助不能脱离CPB。12例采用深低温低流量CPB。CPB中尿量0～450mL,平均(69±25)mL。7例采用超滤的患儿超出液体120～500mL,平均(247±105)mL。停机及术毕HCT分别为0.27和0.33。术后主要并发症为低心排综合征(9)、神经系统损伤(5)、呼衰(3)。结论 婴儿TOF手术的CPB管理是手术成功的一个重要的方面,我们认为:应采用适中的血液稀释和胶体液预充、选择与外科手术相配合的灌注方式、注重术中心脑肺保护。

The management of cardiopulmonary bypass on infants with tetraloge of Fallot

Objective To retrospect the mana-genent of cardiopulmonary bypass (CPB) on infants of Tetraloge of Fallot (TOF). Methods 28 infants of TOP underwent either corrective (25 cases) or palliative (3 cases) procedure. Tins article reviews the methods of CPB including priming, hemodilution, per-fusion pattern and myocardium, brain and lung protection. Results The total CPB time, aortic cross clamp time was (112+ 66) min, and (55 + 16) min respectively. After aortic-clamping release, 28 cases all returned spontaneously. 26 wean from CPB with the support of Dopamine and/or Adrenaline, another 2 couldn't even after long time assistant circulation. 12 adopted deep hypothermia low flow rate perfusion. The urine during CPB was (69 + 25) mL. 7 cases using ul-trafiltration removed liquid 120 ~ 300 mL. The HCT at the end of CPB and operation was 0.27 and 0.33. The main complications were low cardiac output syndrome (9) , neurologic injury (5) and respiratory failure (3) . Conclusions The management of CPB on infants of TOF is an important aspect to successful operation. We emphasize moderate hemodilutin, colloid priming, selecting corresponding perfusion pattern to surgical procedure and giving more attention to intro-operative heart, brain and lung protection.