深低温体外循环在婴幼儿大动脉转位矫治术中的应用

Deep Hypothermia Extracorporeal Circulation for Arteries Switch Operation in Infants

目的分析深低温体外循环在婴幼儿大动脉转位矫治（Switch）术中的运用和技术关键进行探讨和总结。方法回顾本院2004年1月至2006年7月期间,共对131例婴幼儿Switch术采用的深低温体外循环技术。占同期体外循环手术的3.2%。女16例,男115例。年龄从出生7个小时至12个月（3.6±2.2）个月,体重从1.79~8（4.2±1.4）kg。采用深低温低流量（DHLF）14例,深低温停循环（DHCA）5例,深低温停循环结合低流量（DH-CA＋DHLF）112例。所有病例采用pH稳态结合α稳态的血气管理方法。术毕131例均采用改良超滤法（MUF）,其中57例采用传统超滤（CUF）结合改良超滤的方法。结果体外循环时间45~215（126.5±45.2）min;主动脉阻断时间44~160（80.9±26.4）min;停循环时间4~53（18.5±12.6）min;低流量时间8~150（65.4±34.3）min。MUF时间10~15min,滤出液体（229.9±121.3）ml;在体外循环期间CUF时间5~30min,滤出液体（237.8±107.5）ml。体外循环中Hb（86±8.7）g/L,MUF后Hb可达到（118±17）g/L。本组死亡率10.7%,自动复跳率100%。结论新生儿和低体重的婴儿选择在深低温体外循环下进行Switch术更为有利。

OBJECTIVE To summarize the experience of deep hypothermic extracorporeal circuation technique for arteries switch procedure in infants with complete transposition of the great arteries（TGA ） and Tassing-Bing defects.METHODS From Jau.2004 to Jul 2006,131 infants with TGA and Tassing-Bing defects underwent arteries switch procedure.The average of the age and body weight were 3.6±2.2 months and 4.2±1.4 kgs,respectively.Five had operations with deep hypothermia circulatory arrest（DHCA）,forteen with deep hypothermia low-flow rate（DHLF） and 112 with DHLF combined DHCA.RESULTS The total extracorporeal circuation（ECC） time,aortic clamp time,circulatory arrest time and low flow rate（from25 to 50ml/（kg·min）） time were 126.5±45.2 min,80.9±26.4 min,18.5±12.6 min, 65.4±34.3 min,respectively.Modified ultrafiltration（MUF） was used in all babies,MUF combined with conventional ultrafiltration（CUF） was used in 58 babies.CONCLUSION The arterial switch procedure is one of the most complicated procedures for the children and neonates with correcting the congenital cardiac defects,and it should undergo very carefully.So the deep hypothermic cardiopulmonary bypass is suitable for them.