重症婴儿先天性心脏病手术中体外循环的临床策略

目的探讨和总结患有先天性心脏病的重症婴儿进行外科治疗采用体外循环的临床策略。方法回顾总结64例心内直视手术的重症婴儿的临床资料,根据患儿病情的不同,在术中采用浅度低温(24例,37.5%)、中度低温(27例,42.2%)和深低温低流量流转(13例,20.3%)的体外循环方法;心肌保护措施采用不阻断主动脉心不停跳(10例)或阻断主动脉根部间断灌注的方法;术中联合使用改良超滤和普通超滤;术后进行呼吸机支持、改善心脏泵血功能、保护重要脏器和营养支持等监护治疗。结果全部患儿CPB循环时间为41～163 min,平均(105.2±17.3)min,主动脉阻断时间0～84 min,平均(48.32±18.54)min;60例均自动复跳,自动复跳率为93.8%;术后呼吸机支持时间6～149 h,平均(16.9±7.5)h;8例发生并发症,2例死亡,病死率3.1%,其余均痊愈出院。结论首先,从设备选材上来说,应该选择优质的体外循环管道和氧合器;其次,从婴儿患者来说,要根据患儿的具体情况采取合理的预充预案,手术过程中选择合理的体外循环方案,术前要对患儿进行合适的超滤和保护重要脏器的操作;最后,在术后还要对患儿进行监护治疗,保证手术能达到更好的临床效果。

The Clinical Strategies of Cardiopulmonary Bypass in the Surgical Treatment for Infants with the Severe Congenital Heart Disease

Objective To investigate and summarize the clinical strategies of cardiopulmonary bypass(CPB) in the surgical treatment for infants with the severe congenital heart disease(CHD).Methods The clinical data of 64 infants with severe CHD underwent open heart surgery were analyzed retrospectively.According to the conditions of infants,mild hypothermia(24 infants,37.5%),moderate hypothermia(27 infants,42.2%) and profound hypothermia with low-flow perfusion(13 infants,20.3%) during CPB were chosen.The method not blocking the aorta and heart keeping beating(10 cases) or the method blocking the aortic root and taking intermittent perfusion were used to protect myocardium.The modified ultrafiltration and common ultrafiltration were used in the operation.And then the ventilator supporting,improving heart function,protective vital organs and providing nutrition for infants were performed after the surgery.Results The mean CPB time were 41-163(105.2±17.3)minutes,and aortic cross clamping time were 0-84(48.32±18.54)minutes;The heartbeat recovered spontaneously in 60 patients,the rate was 93.8%.The assistant ventilation duration was 6-149(16.9±7.5) hours after operations.And there were 2 cases died(3.1%) and 8 cases had complications appeared,the others were all recovery well.Conclusion Firstly,we should choose quality pipes and oxygenator for CPB.Secondly,reasonable priming and corrected CPB plans for infants were planed according to the patients.Lastly,care treatment must to be provided on infants after operations to ensure that the surgery can achieve better clinical results.