5kg以下婴儿先天性心脏病体外循环管理

目的探讨5 kg以下婴儿先天性心脏病(先心病)(congenital heart diseases,CHD)心内直视手术的体外循环(cardiopulmonary bypass,CPB)管理策略,以减少婴儿先心病术后并发症的发生.方法对5 kg以下婴儿先心病心内直视手术的CPB情况进行回顾性分析.全组34例,年龄13 d至9个月,平均(3.71±2.25)个月、体质量2.5～5.0(4.23±0.59)kg;采用中低温中等流量CPB 18例、深低温停循环(DHCA)3例、深低温低流量CPB(DHLF)9例、DHCA结合DHLF 4例;26例行超滤.结果开放主动脉后心脏自动复跳34例(100%),无严重心律紊乱;32例顺利停体外循环,无严重的CPB并发症.死亡4例,死亡率为11.8%.结论小预充、CPB中较高的血球压积(HCT)和胶体渗透压、充分静脉引流及与温度匹配的足够灌注流量、良好的心肌保护和脑保护是低体重儿成功CPB的关键,适时的超滤是减少CPB术后并发症的有力措施.

Retrospective study of 34 infants less than 5 kg with congenital heart diseases undergoing cardiopulmonary bypass

Objective To improve the management strategy for the infants less than 5 kg with congenital heart diseases (CHD) undergoing cardiopulmonary bypass (CPB). Methods The clinical data of 34 infants including age, sex, body weight and operation type and CPB conditions including equipment, composition of priming liquids, duration of CPB and clamping time of ascending aorta were retrospectively, who were less than 5 kg in body weight and underwent CHD operations. The infants aged 13 d to 9 months, weighed 2.5 to 5 kg. Three patients applied deep hypothermia and circulatory arrest (DHCA), nine patients deep hypothermia low flow rate (DHLF), four DHCA DHLF, eighteen moderate hypothermia and moderate flow rate bypass. Modified ultrafiltration (MUF) was used in 26 patients. Results After cross clamping release (CCR), heart beat recovered spontaneously in all patients without severe arhythmia. Thirty-two cases were successfully weaned from CPB without severe complications. There were 4 early postoperative deaths with a mortality rate of 11.8%. Conclusion Appropriate infant bypass, low prime volume, keeping high Hct and colloidal pressure, adapted perfusion flow rate matching temperature, myocardial preservation and brain protection during CPB can lead to good results. Meanwhile, adapted ultrafiltration will minimize complications after CPB and enhance the success rate of operation.