深低温停循环在新生儿及小婴儿心脏手术中的应用

Application of Deep Hypothermic Circulatory Arrest during Open Heart Surgery for Neonates and Small Infants

目的探讨深低温停循环（DHCA）在新生儿及小婴儿复杂先天性心脏病（CHD）矫治术中的脑保护效果和对其他系统的影响。方法2006年1月至2007年12月44例复杂CHD患儿在DHCA下实施了心脏畸形矫治术,年龄8-150（67.54±46.65）天,体重1.13-5（3.87±1.17）kg。停循环过程中维持鼻咽温18℃-20℃,肛温18℃-21℃,DHCA时间5-60（30.5±12.2）m in。结果术中死亡4例,术后早期死亡4例,总死亡率18.2%;2例（4.5%）因神经系统并发症死亡,其余病例未发现神经系统并发症;术后苏醒时间1-12（7.7±6.5）h,呼吸机辅助时间9-123（61.1±9.3）h,ICU时间41-260（83.5±36.4）h,住院天数13-66（27.3±12.6）天;术后腹膜透析10例（22.7%）,出院时复查肾功均正常;术后前三天引流25.9-85.7（58.9±24.4）m l/kg,围术期红细胞用量0-1.2（0.64±0.40）U/kg。结论在新生儿及小婴儿复杂心脏手术中,深低温停循环仍然是有效和实用的脑保护措施。随着外科和体外循环技术的进步,手术后死亡率和并发症将会进一步降低。

OBJECTIVE To investigate the neuro-pretective effect of deep hypothermic circulatory arrest（DHCA） and its impact on other major organs during the open heart surgery for neonates and small infants.METHODS From January 2006 to December 2007,44 cases with complex congenital heart diseases,aged 8-150 days and weighed 1.13-5 kg underwent open heart surgery with DHCA.Nasopharyngeal temperature was kept at 18℃-20℃ and rectal temperature at 18℃-21℃ in the course of DHCA.The duration of circulatory arrest was 5-60（30.5±12.2）min.RESULTS 4 patients died intra-operation and 4 patients died post operation,the peri-operative mortality was 18.2%,2 cases（4.5%） were caused by neurological complication.No neurological deficits were found in other patients.The palinesthesia time after operation was 1-12（7.7±6.5） h,the mechanical ventilation time was 9-123（61.1±9.3） h,ICU stay time was 41-260（83.5±36.4） h,the date of hospital stay was 13-66（27.3±12.6） days.There were 10 cases（22.7%） of new-onset dialysis in the study cohort,all patients with new-onset renal dysfunction recovered when discharged.The total chest tube drainage for the first 3 postoperative days was 25.9-85.7（58.9±24.4） ml/kg and red blood cells transfused was 0-1.2（0.64±0.40）U/kg.CONCLUSION DHCA is still a simple and effective method for central nervous system protection during the open heart surgery for neonates and small infants.With the improvement of cardiac surgery and extracorporeal circulation skills,reductions in mortality and morbidity will be likely achieved in the future.