186例10公斤以下婴儿体外循环经验

Cardiopulmonary bypass for surgery of 186 infants with a body weight of less than 10 kg

目的 总结１８６ 例体重１０ ｋｇ 以下婴儿体外循环手术过程中灌注经验。方法 本组婴儿体外循环手术，预充液量７５０ ～１ １５０ ｍｌ，ＨＣＴ２３．５ ±１％ ，血浆总蛋白４０ ．８ ±５ ．７ ｇ／Ｌ，在部分复杂畸形患儿，应用中度低温（ 肛温２３ ～２５℃） 低流量（每ｍｉｎ ０．８２±０．１ Ｌ／ｍ２ 或每ｍｉｎ ３７ ．６ ±５ ．５ ｍｌ／ｋｇ） 灌注技术，平均体外循环时间６２ ±５ ．７ ｍｉｎ，心停跳时间３５．８ ±１７ ｍｉｎ。结果 全组１８６ 例患儿都顺利地脱离体外循环，１２ 例术后因低心排综合征死亡，占６．４％ ，３ 例出现神经系统并发症，占１．６ ％ 。结论 此种体外循环方法，适用于１０ ｋｇ 以下不同类型的婴儿心血管病手术。

Objective To review the clinical experience of cardiopulmonary bypass (CPB) in 186 infants with a body weight of less than 10 kg (8.4±0.67 kg ) during the open heart operation.Methods All patients received the congenital heart disease correction operation with cardiopulmonary bypass. The prime volume was 750～1 150 ml, HCT was 23.5±1%, and total plasma protein was 35.5±5 g/L. The average total CPB time and aortic cross clumping time were 62±5.7 min and 35.8±17 min respectively. In 30 infants, who had complex cardiac malformation, moderate hypothermia was used at a rectum temperature of 23～25℃ with a lower perfusion flow of 0.82±0.1 L/m 2(37.6±5.5 ml/kg per min) per min. Results All patients smoothly passed CPB. Twelve cases (12/186) died due to low heart output syndrome after operation. Three of them (3/12) suffered from neurologic complications.Conclusions The cardiopulmonary bypass is an adequate strategy for open heart surgery in infants with a body weight of less than 10 kg.