成人法乐四联症根治术的体外循环管理

Management of cardiopulmonary bypass for total correction of tetralogy of fallot in adult patients

目的成人法乐四联症在病理生理上与儿童有较大区别,故术中体外循环也应区别对待,我们总结我院成人法乐四联症(TOF)根治术的体外循环管理方法。方法 64例TOF患者,体外循环转流前全部进行自体血体外储存,血液稀释后HCT维持在25%～28%,体外循环(CPB)转流中采用中度低温和深低温低流量体外循环灌注。结果 64例患者体外循环转流时间86～161(118.6±23.7)min;主动脉阻闭时间32～120(51.4±13.1)min;低流量灌注时间12～41(21.5±6.2)min。手术后低心排5例,急性肾功能衰竭1例,二次开胸止血2例,乳糜胸2例,病死率4.69%(3/64)。结论由于成人TOF患者心脏和肺血管的慢性病变严重,手术野回血多,在体外循环中应加强心肌保护和血液保护;同时保持适当胶体渗透压、合适的低温、合适的灌注流量可以预防手术后并发症的发生。

Objective To summarize the management method of cardiopulmonary bypass （CPB） for total correcting of Teralogy of fallot（TOF） in adult patients in department of cardiothoracic surgery of Chengdu Military General Hospital.Methods 64 adult patients were diagnosed of TOF.All patients had been bloodletted from aortic root before CPB,keeping HCT 25%~28% after hemodilution.The moderate hypothermia and deep hypothermia low flow were used during surgery in CPB.Results 64 cases CPB duration was 86~161（118.6±23.7）min;Aorta clamp-time was 32~120（51.4±13.1）min;low flow perfusion time was 12~41（21.5±6.2）min.Postoperative low cardiac output,acute renal failure,second operation for haemostasising,chylothorax were present in 5、1、2、2 cases respectively.The mortality in whole was 4.69%（3/64）.Conclusion Because of the physical and pathological characteristic in adult patients with TOF,during operation time,more blood pervased in operating field;So we should strengthen myocardial preservation and blood preservation during CPB time on one hand;and on the other hand appropriate colloid osmotic pressure,appropriate hypothermia,appropriate perfuse flow rate may do favor preventing postoperative complication.