低出生体重儿心内直视术的体外循环管理

Extracorporeal circulation of cardiac surgery in neonates with low birth weight

目的总结低出生体重儿（≤2.5 kg）心内直视术的体外循环（ECC）管理经验。方法对我院34例低出生体重先天性心脏病患儿行心内直视术的ECC情况进行回顾性分析。男性22例,女性12例,出生体重1 130-2 500（2 278.3±444.6）g;孕周28-42（36.5±3.29）周。手术时日龄为3-80（23.9±15.4）d,手术日体重1 130-2 700（2 193.2±349.6）g。其中早产儿15例。所有患儿均在全身麻醉ECC下完成心内畸形矫治手术。其中深低温停循环（DHCA）2例,深低温低流量（DHLF）15例,ECC中度低温中低流量11例,浅低温中高流量3例,常温不停跳3例。1例术中给予平衡超滤（ZBUF）结合常规超滤（CUF）和改良超滤（MUF）,其余均给予CUF联合MUF。结果本组病例无术中死亡。ECC转流时间35-235（109±55.9）min,主动脉阻断时间14-125（59.8±28.2）min。所有病例在开放主动脉后心脏均自动复跳,并成功脱离ECC,14例延迟关胸。术后早期死亡8例,死亡率23.5%。结论防止液体潴留,良好的心肌保护、脑保护,选用适宜的灌注方式有助于降低围术期的死亡率和并发症发生率,并提高术后生存率。

OBJECTIVE To summarize the experience of extracorporeal circulation（ECC） in the low birth weight neonates（≤2.5kg） with congenital heart disease（CHD）.METHODSWe reviewed the clinical protocols of ECC of cardiac surgery in 34 low birth weight infants（LBWI）.22 males and 12 femals,The mean birth weight,gestational age,age and weight at operation were（2278.3±444.6）g（ranged from 1130 g to 2500 g）,（36.5±3.29） weeks（ranged from 28 weeks to 42 weeks）,（23.9±15.4）d（ranged from 3 d to 80 d） and（2193.2±349.6）g（ranged from 1130 g to 2700 g） respectively.Among these cases were 15 premature infants.All cases underwent cardiac operations with ECC and general anaesthesia.The study included 2 with deep hypothermia circulatory arrest（DHCA）,15 with deep hypothermia low flow（DHLF）,11 with moderate hypothermia bypass,3 with mild hypothermia and another 3 underwent normal temperature ECC with on-beating heart bypass.Zero-balance ultrafiltration（ZBUF） plus conventional ultrafiltration（CUF） and modified ultrafiltration（MUF） were used in 1 cases and CUF combined MUF were used in other cases during ECC.RESULTS No intra-operative death occurred in this group.The mean ECC times were 35-235（109±55.9） min,and aortic cross clamping time were 14-125（59.8±28.2） min.The heartbeat recovered spontaneously in all patients after cross clamping release（CCR）,successfully weaned from ECC,and the sternum left open in 14 cases.There were 8 hospital deaths with mortality 23.5%.CONCLUSION Avoidance of fluid retention,favourable myocardial and cerebral preservation,suitable ECC modes are beneficial to the decrease of mortality and promotion of survival rate in LBWI with CHD undergoing open-heart surgery.