260例半岁内危重先天性心脏病急诊体外循环

Application of cardiopulmonary bypass for 260 infants with severe and emergent congenital heart disease within 6 months

目的探讨危重婴幼儿体外循环(CPB)方法,为危重婴幼儿心脏手术的安全实施提供一定的经验。方法 2006年1月至2010年12月,我科施行半岁内危重婴幼儿先天性心脏病手术260例,男156例,女104例,年龄3 d至6个月,平均(4.1±2.2)月,体重2.1～8.3 kg,平均(4.2±1.3)kg。CPB预充液以林格氏液为主,使晶胶比维持在(0.35∶1)～(0.6∶1),血细胞容积25%～28%。心肌保护均采用含血停跳液。CPB使用进口膜肺249例(95.8%),国产膜肺11例(4.2%),转流方式包括浅低温体外循环心脏不停跳转流33例,中低温体外循环心脏停跳转流168例,深低温低流量转流57例和深低温停循环2例。转流时间15～238 min,平均(78±36)min;阻断时间6～159 min,平均(47±23)min;术中使用改良超滤和/或普通超滤233例(89.6%),滤出液体50～650 mL,平均(230±140)mL。结果术后呼吸机支持时间5～176 h,平均(16.5±8.6)h;入住ICU时间48～202 h,平均(72.6±29.8)h;术后住院时间12～28 d,平均(16.2±4.7)d。术后发生低心排28例(10.8%),肺、脑、肝、肾等重要脏器并发症30例(11.9%)。全组死亡22例(8.5%),死亡原因包括低心排15例,心律紊乱3例,呼吸衰竭2例,因喂养不当误吸窒息1例,多器官功能衰竭1例。其余患儿恢复顺利,未发生与体外循环相关并发症,康复出院。结论 CPB期间和术后的液体管理及高质量CPB器材的使用可减少术后并发症发生。

Objective To explore the methods of cardiopulmonary bypass（CPB） in surgery for infants with severe and emergent congenital heart disease in order to provide references for the related surgery.Methods Totally 260 infants within 6 months were underwent surgery for severe and emergent congenital heart disease from January 2006 to December 2010.There were 156 males and 104 females,the age is from 3 day to 6 months,（4.1±2.2） months in average,the weight is 2.1～8.3 kg,（4.2±1.3） kg in average.The priming solution of CPB was mainly the Ranger＇s,the ratio of crystal and colloid was maintained between（0.4∶1） and（0.5∶1） and the Hct was 25%～28%.The cardioplegia fluid with blood was used in all patients during CPB.The imported membrane oxygenator was used in 249 cases（95.8%） and the membrane oxygenator made domestically was used in 11 cases（4.2%）.The methods of CPB included mild hypothemia with beating-heart in 33 cases,moderate-low hypothermia with arresting-heart in 168 cases,deep hypothermia with low flow perfusion in 57 cases and deep hypothermic circulatory arrest in 2 cases.The duration of CPB was 15～238 minutes,（78±36） minutes in average and aortic cross-clamping time was 6～159 minutes,（47±23） minutes in average.The modified and /or conventional ultrafiltration were used during operation in 233 cases（89.6%） and ultrafiltration fluid was 50～650 mL,（230±140） mL in average.Results The assistant ventilation duration was 5～176 hours,（16.5±8.6） hours in average;intensive care unit duration was 48～202 hours,（72.6±29.8） in average;hospitalization duration was 12～28 days,（16.2±4.7） days in average.The morbidity of low cardiac output syndrome（LCOS） was 10.8%（28/260） and incidence of complications concerning other important organs（lung,brain,liver,kidney,etc） was 11.9%（30/260）.There were 22 cases（8.5%） died including 15 cases of LCOS,3 cases of arrhythmia,2 cases of respiratory failure,1 case of asphyxia due to incorrect feed and 1 case of multi-organs dysfunction.The others were recovered well and no complication correlated with perfusion was found.Conclusion Reasonable fluid management during CPB and after operation as well as adopting high-quality equipments can prevent the complications postoperatively.