复杂先天性心脏病术中体外循环处理与脏器保护

Management of Extracorporeal Circulation Performed on the Children with Complicated Congenital heart Disease and Protection of Their Important Organs

目的：探讨复杂性先天性心脏病（CHD）矫治术中体外循环（ECC）管理方法及重要脏器的保护措施。方法：对27例复杂性CHD患儿根据畸形的复杂程度和手术时间的长短，采用浅、中或深低温体外循环，中度血液稀释，术中维持灌注流量150～180ml／kg·min，控制预充量，体外循环中进行超滤，加强心肺脑肾等重要脏器的保护。结果：体外循环时间68—178min，主动脉阻断时间45～128min，尿量100—420ml，均顺利停机。结论：高钾含磷酸肌酸钠冷晶体停搏液为心肌提供有效的保护，ECC中维持满意的MAP，应用白蛋白、乌司他丁、甲基强的松龙和超滤等有助于脑、肺、肾等重要脏器的保护。

Objective： To analyze the management of extracorporeal circulation （ECC） performed on the children with complicated congenital heart disease （CHD） , who were hospitalized in our hospital recent two years, and summarize the protection of their important organs. Methods：The data from twenty seven cases with CHD was analyzed retrospectively. According to the patients＇operative duration and the degree of cardiac anisot- rophy, the superficial, moderate or profound hypothermia of ECC were adopted respectively. Meanwhile, to maintain medium hemodilution, filling flow of 150 - 180ml/kg/min, and mean arterial pressure （MAP） surpassing 30mmHg during the operations. During the procedures, red blood cells, blood plasma, albumin, ulinastatin and et al were added in advance, and methylprednisolone at the dosage of 30mg/kg was routinely supplemented. Sodium phosphacreatine of 1 -2g was added into solution of myocardial preservation and uhrafiltration was carried out. Results：The durations of ECC and aorta blockage were 68 - 178 minutes and 45 - 128 minutes, respectively. The discharge of urine was satisfaction, approximately 100 -420ml. all the patients was pulled out trachea pipe successfully within 8 - 10 hours after returning to ICU. Conclusions： The cardioplegic solution including sodium phosphcreatine could provide protection for the cardiac muscle. Maintaining satisfactory MAP and making use of albumin, ulinastatin, methylprednisolone and uhrafiltration could protect the important organs including brain, lung, kidney and et al from damages.