心脏跳动下全腔静脉肺动脉连接术体外循环管理

Cardiopulmonary Bypass for Fontan operation with Extracardiac Conduit on Beating Hearts

目的回顾性总结52例心脏不停搏下心外管道Fontan手术的体外循环特点。并对有关问题进行讨论。方法本组52例中,男性41例,女性11例,年龄3～23岁,其中心室双入口19例,三尖瓣闭锁20例,二尖瓣闭锁3例,其他复杂先天性心脏病10例。均在常温体外循环心脏不停搏下施行心外管道Fontan手术,其中8例加用开窗术,6例先做了双向腔肺动脉分流术,术后2年行心外管道Fontan手术。术前血红蛋白平均195g/L。体外循环时间(121±8)min,肛温维持在32～34℃之间。结果术后早期和晚期各死亡1例,分别死于急性肝功能衰竭和反复肺部感染,50例心功能为Ⅰ级和Ⅱ级,动脉血氧饱合度92%～96%。结论心脏不停搏下心外管道Fontan手术的体外循环中将血红蛋白维持在80～90g/L,除预充晶体外并加入胶体白蛋白和血浆及血浆代用品以保持一定的胶体渗透压.并且进行超滤减轻机体水负荷及减轻炎性介质对机体反应,改善心肺功能促进各脏器功能恢复的效果。

OBJECTIVE To study the experience of cardiopulmonary bypass for Fontan operation with extracardiac conduit on beating hearts. METHODS 52 patients (41 males and 11 females), age ranged from 3 to 23 years old . There were 19 double inlet-ventricle, 2 tricuspid atresia, and 3 patients with mitral atresia, 10 patients with other complex congenital cardiac malformations. Fontan operations with extracardiac conduit were performed in all patients with normothermic cardiopulmonary bypass without csrdiac arrest. Atrial septal fenestration was performed in 8 patients.In 2 patients, bi-directional Cardiopulmonary procedure was performed 2 years before Fontan operation. RESULTS There was one early death caused by acute hepatic function failure and one late death caused by repeated lung infections. The follow-up of 1 to 4.5 years showed that all patients' cardiac functions were grade Ⅰ to Ⅱ, and arterial oxygen saturation was 92～96%. CONCLUSION The early and extended outcome of Fontan operation with extracardiac conduit on beating hearts was good and the method could be used in the single ventricle repair.