小儿先天性心脏病并肺动脉高压的体外循环管理

The management of cardiopulmonary bypass in the correction of congenital heart disease and pulmonary hypertension in 100 patients undergoing open heart surgery

目的:回顾性总结先天性心脏病合并肺动脉高压的患儿在心内直视纠治术中体外循环(CPB)的管理经验。方法:对100例小儿CPB手术患者,使用stockerⅢ型心肺机及膜式氧合器,其中轻度肺动脉高压50例,中度38例,重度12例。CPB采用浅低温、中度血液稀释、高流量。转流中常规使用硝普钠、凯时,部分婴幼儿使用超滤技术。结果:CPB35～181min,阻断主动脉20～120min,血气分析、电解质监测正常。全部患儿心脏自动复苏,无死亡和并发症。结论:先心病合并肺高压CPB转流中,应特别注意心肌保护、肺保护、酸碱平衡、电解质紊乱的纠正和扩血管药物以及超滤技术的应用。

Objective To summarize retrospectively the management experiences ot congenital heart disease and pulmonary hypertension of children who underwent open heart surgeries. Methods： Strocker Ⅲ heart-lung machine and film oxygen machine were applied to 100 cases of congenital heart disease and pulmonary hypertension, among whom 50 cases suffered with mild HP, 38 cases with moderate HP, 12 cases with severe HP. Low temperature, moderate blood dilution and high flow were adopted. Sodium nitroprusside and Alprostadil injection were applied routinely. Ultrafiltration was applied in portion of infants.Results： The time of extracorporeal circulation was from 35 minutes to 181 minutes, and aorta crass clamping from 20 to 120 minutes. Blood gas analysis and electrolytes monitoring were within normal range. Autoresusciation occurred in every heart, no death and complication.Conclusion Myocardial preservation , pulmonary protection , acid - base balance and electrolyte disturbance , ultrafiltration and vasodilatoin should be attempted during extracorporeal circulation.