单泵双管在婴幼儿主动脉缩窄或主动脉弓离断合并心内畸形Ⅰ期矫治术中的应用

Application of double arterial lines with single pump head perfusion in stageⅠrepair of aortic coarctation or interrupted aortic arch complicated with cardiac monstrosity in infants

目的探讨单泵双管体外循环灌注技术在婴幼儿主动脉缩窄或主动脉弓离断合并心内畸形行Ⅰ期矫治术中的应用。方法对2002年4月至2010年5月收治的14例主动脉缩窄或主动脉弓离断合并心内畸形患儿施行心内畸形Ⅰ期矫治术。体外循环采用单泵双管灌注技术,6例在鼻咽温度25℃,直肠温度26℃的中度低温完成心内畸形及主动脉缩窄矫治;8例在鼻咽温度降至18～20℃,直肠温度降至19～22℃采用深低温停循环合并间断深低温低流量进行灌注。结果术中停循环时间19～43min,平均(31.38±4.88)min,间断低流量灌注时间8～21 min,平均(13.16±4.72)min。所有患儿均未出现中枢神经系统并发症和肾功能衰竭,顺利康复出院。结论在婴幼儿主动脉缩窄或主动脉弓离断合并心内畸形进行Ⅰ期矫治术时采用单泵双管上下同时灌注的体外循环方法安全、有效,能有效保护机体重要脏器。

Objective To explore the application of double arterial lines with single pump head perfusion in stageⅠrepair of aortic coarctation or interrupted aortic arch complicated with cardiac monstrosity in infants.Methods StageⅠrepair was performed on 14 patients with aortic coarctation or interrupted aortic arch complicated with cardiac monstrosity from April 2002 to May 2010.The technique of double arterial lines with single pump head perfusion was employed in cardiopulmonary bypass.Six cases finished the surgery at moderate hypothermia（nasopharynx temperature at 25 ℃ and rectum temperature at 26 ℃）.Deep hypothermia circulatory arrest（DHCA） combined with deep hypothermia low flow（DHLF） for perfusion was applied in eight cases after the nasopharynx temperature being maintained at 18～20 ℃ and the rectum temperature at 19～22 ℃.Results The duration of DHCA was 19～43 minutes,（31.38±4.88）minutes in average and the duration of DHLF was 8～21 minutes,（13.16±4.72）minutes in average.All 14 infants were recovered and there was no neurological complication.Conclusion The application of double arterial lines with single pump head perfusion in stageⅠrepair of aortic coarctation or interrupted aortic arch complicated with cardiac monstrosity in infants is safe and effective,especially for the protection of the important body organs.