10kg以下婴幼儿法洛四联症的体外循环管理

目的探讨婴幼儿法洛四联症矫治术的体外循环（CPB）管理与经验。方法分析71例10Kg以下婴幼儿法洛四联症矫治术的体外循环管理经验：根据不同手术方式术中采用中度低温和深低温低流量灌注的体外循环方法,心肌保护措施采用主动脉根部间断灌注4∶1冷血停搏液,复温后行平行超滤与改良超滤联合应用。结果16例采用中度低温中流量灌注,54例采用深低温低流量CPB下行法洛四联症矫治术,CPB时间为59-243min,阻断主动脉时间39-126min;1例采用深低温停循环CPB下行法洛四联症矫治术,CPB时间为114分钟,阻断主动脉时间56分钟,停循环5分钟,68例开放主动脉后自动复跳,自动复跳率为95.8%,65例停机顺利,6例停机困难,术后死亡2例,死亡率为2.8%。结论制定合理的预充预案,选择高质量的膜式氧合器,适当的血液稀释,深低温低流量灌注技术及超滤的应用是提高婴幼儿法洛四联症CPB质量的关键。

Management of cardiopulmonary bypass in infant with tetralogy of Fallot

Objective To disccus the cardiopulmonary bypass in infants with tetralogy of Fallot （TOF） in open heart surgery. Methods 71 cases of the cardiopulmonary bypass within 10kg in infants with TOF were summarized. Moderate hypothermia and profound hypothermia low flow perfusion CPB were performed according different procedures. Heart arrest were by 4：1 cold blood fluid through aortic root, paralleled and modified ultrafiltration were executed after rewarming. Results 16 cases were operated with moderate hypothermia and 54 cases with profound hypothermia low flow perfusion during the TOF surgical procedures. CPB time was 59-243min. Clamped time was 39- 126min. One case was performed with TOF surgical procedures with 5 rain hypothermia arrest and 114 min CPB, which clamped time was 56rain. 68 cases （95.8%） recovered heart beating automaticly after clamp removed, 6 cases retied CPB formidable. The mortalities of infants was 2.8%（2/71）. Conclusion Reasonable priming, high quality of memhrance oxygenator during CPB, proportionate hemodilution, profound hypothermia low flow perfusion CPB and modified ultrafiltration were crucial factors to improve CPB for TOF procedures in infants.