婴幼儿心内直视手术的体外循环管理策略

婴幼儿心内直视手术的体外循环管理策略状物的作文

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摘要目的总结婴幼儿先天性心脏病心内直视手术中的体外循环管理技术与方法.方法回顾该院1996年3月~2003年4月208例婴幼儿先心病术中体外循环情况,采用中度低温、中高流量灌注,灌注流...

摘要 目的总结婴幼儿先天性心脏病心内直视手术中的体外循环管理技术与方法.方法回顾该院1996年3月~2003年4月208例婴幼儿先心病术中体外循环情况,采用中度低温、中高流量灌注,灌注流量80~150ml/kg·min,10 kg以下高达200mi/kg·min.预充液以胶体为主,晶胶比为0.06~0.6.重症婴幼儿应用超滤技术.维持术中平均动脉压30~80mmHg,心肌保护采用主动脉根部顺行灌注为主,结合其它方式,主要采用4:1含氧血灌注,部分采用冷晶体灌注.结果全组体外循环时间20~216min,平均(59.9±33.9)min,主动脉阻断时间4~139min,平均(34.6±22.9)min.心脏自动复跳率96.5%.转流中尿量平均240ml,超滤量平均430ml,全组均顺利停机,术后死亡11例,死亡率5.2%.结论婴幼儿体外循环有其特殊性,根据惠儿的病情制定周密的灌注计划,选择适宜材料和灌注方式,着重心肺保护,同时运用超滤技术,对提高术后成功率起着重要作用. Objective: To summarize the management of cardiopulmonary bypass(CPB) on infants with congenital heart disease. Methods: From March 1996 to April 2003, 208 infants were operated under moderate hypothermia and high perfusing flow, the blood flow was 80~150 ml/(kg·min), 200 ml/(kg·min) less than 10 kg weight, critical congenital heart disease were applied with modified ultrafiltration (MUF), perfusion pressure kept 30~80 mmHg. Cardioplegia were applied with 4:1 oxygenated blood or cold crystalloid infused through aortic root respectively. Results: The CPB time ranged from 20 to 216 minutes, the aortic clamped time from 4 to 139 minutes. the cardic spontaneous defibrillation rate was 96.5%, the average volume of ultrafiltration in MUF was 430 ml, the urine was 240 ml, 11 patients died after operation and the mortality rate was 5.2%. Conclusions: CPB in infants has speciality, selecting the proper CBP method, using material with less priming volume, applying MUF, strengthening protection of myocardial and lung function are very important to improve the successful outcome.

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