婴幼儿法洛氏四联症治疗的体外循环管理

Management of cardiopulmonary bypass in babies and infants treatment Fallot tetralogy.

目的总结27例婴幼儿法洛氏四联症(TOF)矫治术的体外循环管理,提高TOF矫治术的成功率. 方法体外循环(CPB)采用中度低温中流量和深低温低流量,心肌保护为主动脉根部间断灌注冷晶体停博液及心脏表面覆盖冰泥.大部分术中传统超滤和停转流后改良超滤联合应用. 结果 CPB时间为52～190min,主动脉阻断时间为37～115min,心脏自动复跳率为97%,无严重的CPB并发症,术后3例因发生严重低心排综合征死亡. 结论合理的预充液配置、心肌保护、肺保护及超滤技术的应用是提高CPB质量和提高手术成功率的关键.

Objective To summarize clinic experience of eardiopulmonary bypass（CPB） in treatment of 27 tetralogy of Fallot infants and children patients undergoing operation. Methods Twenty - seven infants and children patients were performed CPB with moderate - hypothermia and mild flow and myocardial protection by means of intermminent perfusion cold crystal eardioplegie solution into aorta and cover ice on the surface of the heart .The combination of ＂traditional ultrafiltration during CPB and modifed ultrafdtration after CPB was ehoosen. Results The time of CPB was 52 - 90 min, the time of aorta blockade was 37 - 115min. The rate of auto - rebeat was 97 percent, No severe complication related to CPB was found, and 3 patients were died of severe cardiac low output syndrome after operation. Conclusion Proper preperation of prime fluid, myocardial protection pulmonary protection and the using of ultrafltration are the key measures to improve the quality of CPB.