138例法洛四联症根治术的体外循环管理

Extracorporeal circulation management on 138 cases of total correction of TOF

目的总结138例法洛四联症(teiralogyoffallot,TOF)根治术体外循环转流(cardiopulmonarybr-pass,CPB)的方法与经验。方法全组均在体外循环下行法洛四联症根治术,通过实施低温,中深度血液稀释,维持合理胶渗压,超滤和药物处理等技术,保护患者心、脑、肺、肾、血液等功能。结果该组患者体外循环期间血流动力学基本稳定,血气电解质维持在正常范围,6例停机后血压难以维持,经超时低流量辅助后顺利脱机。全组死亡6例,死亡率4.3%。3例死于术后严重低心排综合征,2例死于肺部并发症,1例死于术后高热,其余患者术后顺利康复出院。结论中深度血液稀释,保持机体内环境稳定,良好的心肺和血液保护是法洛四联症根治术中体外循环管理的关键。

[Objective] This paper aims to sum up the methods and experience concluded from extracorporeal circulation performed on 138 patients during the total correction of TOF. [Methods] All the 138 patients were conducted the total correction of TOF in hypothermia extraeorporeal circulation. During the course, the function of patients, heart, brain, lung, kidney and blood was preserved by carrying out moderate-deep hemodilution, maintaining proper colloid osmotic pressure, and using drugs. [Results] The hemodynamics of the patients was normal during the course. Blood gas electrolyte was kept in a nomal extent. The blood pressure appeared unstable in six patients when the circulation course ended, but stayed steady after the ultrafiltration and assistance of overtime low output were performed. Three patients died of serious LCOS after surgery and two died of pulmonary complication. The rest of the patients were reeoverd and discharged from hospital. [Conclusion] Conducting the moderate-deep hemodilution, maintaining the inner stability, and preserving the cardiopulmonary and blood function are key to performing the extracorporeal circulation during the total correction of TOF.