一期Norwood手术的体外循环管理

Extracorporeal Circulation in the First Stage of Norwood Procedure for Hypoplastic Left Heart Syndrome

目的总结一期Norwood手术中的体外循环方法。方法2004年7月至2008年6月，5例患儿诊断左心发育不良综合征，平均年龄（2．3±2．8）个月，平均体重（4．2±0．9）kg。均在深低温停循环下开展一期Norwood手术，停循环期间，3例采用脑部顺行灌注，流量10～15ml／kg。使用常规超滤和改良超滤技术。结果平均体外循环时间为（222±104）min，平均主动脉阻断时间（110±35）min，平均停循环时间（53±25）min，最低肛温（19．2±1．2）℃。停机时红细胞比积为（0．37±0．02）。死亡2例，1例术后低心排、毛细血管渗漏综合征。另1例术前乳酸值大于15mmol／L，不能脱离体外循环。结论深低温停循环适合一期Norwood手术，脑部顺行灌注有利于延长停循环时间，较高的红细胞比积对患儿术后组织供氧有益。

OBJECTIVE To summarize the cardiopulmonary bypass managements in the first stage of Norwood procedure for hypoplastic left heart syndrome. METHODS Five patients with hypoplastic left heart syndrome underwent first stage of Norwood procedure under deep hypothermic circulation arrest between July 2004 and June 2008. The mean operative age was （2.3 ± 2.8）months and mean body weight was （4.2 ±0.9） kg. Antegrade cerebral perfusion was performed at 10 - 15 ml/kg in three cases during deep hypothermic circulation arrest. Conventional and modified uhrafihrations were applied in all cases. RESULTS Mean duration of cardiopulmonary bypass was （222 ± 104） min and mean cross - clamping time was （ 110 ±35 ） rain. Mean duration of circulation arrest was （ 53 ± 25 ） min and the lowest rectal temperature was （ 19.2 ± 1.2） ℃. Mean hematocrit after weaning off cardiopulmonary bypass was （0.37 ± 0.02）. One patient died from low cardiac output syndrome and capillary leakage syndrome and the other patient with preoperatively high levels of serum lactate eouldnt wean off eardiopulmonary bypass. CONCLUSION Deep hypothermic circulation arrest could be recommended in the first stage of Norwood procedure for hypoplastic left heart syndrome. Antegrade cerebral perfusion is benefit for cerebral protection during deep hypotbermic circulation arrest. Ultrafihration promotes hematocrit to enhance the blood oxygen capacity.