动脉导管未闭合并心内畸形手术死亡原因分析

目的探讨动脉导管未闭(PDA)合并心内畸形病人手术死亡原因。方法本组12例在中度血液稀释、其中5例采用中度低温、7例深低温低流量(DHLF)体外循环(CPB)和冷氧合血及冷晶体停搏液间断灌注心肌保护下行心内畸形矫治。结果死于急性肾功能衰竭5例，低心排综合症3例，多脏器功能衰竭2例，灌注肺1例，肺、脑梗塞1例。结论急性肾功能衰竭死亡原因可能与动脉灌注流量、温度及术前肾功能不全和CPB前发生出血性休克有关；漏诊的PDA是导致灌注肺的直接原因；肺、脑梗塞及多脏器功能衰竭的发生可能是综合因素所致。

Analysis of Perioperative Death in Patent Duct Arteriosus with Intracardiac Malformations

OBJECTIVE To analysis the causes of perioperative deaths in patent duct arteriosus (PDA) with intracardiac malformations. METHODS 123 patients underwent intracardial surgery under CPB, employing mild hemodilution, mild hypothermia, deep hypothermia and low flow. The methods of myocardial preservation were cold-blood cardioplegia and cold crystal cardioplegia.RESULTS There were 12 perioperative death. The causes included acute renal failure (5cases), low cardiac output syndrome (3cases), multiple organ function failure(2 cases ), perfusion lung (1cases),and cerebral infarction (1cases),The main cause of acute renal failure possible related to arterial perfusion flow, temperature, preoperative renal dysfunction and hemorrhagic shock before CPB; postoperative perfusion lung was related to missed diagnosis PDA. In 3 cases, intracardiac maneuvers were complicated and lengthened. They died of lung and cerebral infarction and multiple organ function failure after operation.CONCLUSION The causes of perioperative death in PDA with intracardiac malformations were acute renal failure , low cardiac output, multiple organ function failure, perfusion lung and cerebral infarction .