发绀婴幼儿心脏不停跳下行姑息性右心室-肺动脉连接术的体外循环管理

Management of cardiopulmonary bypass with beating heart during the first stage palliative operation for cyanotic infants with right ventricle to pulmonary artery shunts

目的总结发绀型先天性心脏病患儿（术前红细胞比容〉45％）在心脏不停跳下行姑息性右心室．肺动脉连接术的体外循环（CPB）管理要点。方法回顾性总结2009年9月至2011年6月17例发绀患儿在心脏不停跳CPB下完成姑息性右心室-肺动脉连接术的临床资料。男10例，女7例；中位月龄9．7个月（2．5～73．8）个月；体质量（8．3±3．4）kg。维持在浅低温CPB状态，通过术中放血和预充新鲜冷冻血浆以达到合理血液稀释，调整流量保持心脏在适度低前负荷状态下跳动，全程行常规＋平衡＋改良性超滤，应用血液回收装置行血液保护。结果新鲜冷冻血浆用量为（285．6±27．9）mL，温度维持在（34．2±1．8）℃，灌注流量为55-100mL/kg。术中动脉压为（5．7±0．6）kPa，尿量为（12．1±5．7）mL/kg。转流中无一例发生心室颤动，全组患儿CPB时间为（76．2±36．4）min，术后气管插管时间为（55．7±45．3）h，术后住院时间为（12．7±6．5）d。患儿均存活。结论通过合理实施CPB管理策略，可保证发绀患儿在心脏不停跳CPB下顺利完成姑息性右心室．肺动脉连接术，并有效减少术后并发症的发生。

Objective To summarize the clinical experiences of cardiopulmonary bypass （CPB） with beating heart during the first stage palliative operation for right ventricle to pulmonary artery shunts in cyanotic infants. Methods A retrospective analysis on 17 cases of cyanotic infants underwent right ventricle to pulmonary artery shunts from Sep. 2009 to Jun. 2011 was performed. Ten cases were male and 7 cases were female. The median age was 9.7 months （2.5 - 73.8） months, and the median weight was （ 8.3 ± 3.4 ） kg. All infants were finished under mild hypothermia CPB and reasonable hemodilution with fresh frozen plasma, maintained with beating heart under lower preload. Conventional uhrafihration,zero-balance and modified ultrafihration were all applied in the whole CPB procedure. Re- suits The average fresh frozen plasma volume was （ 285.6 ± 27.9 ） mL. The average temperature was （ 34.2 ± 1.8） ℃. The perfusion flow ranged from 55 to 100 mL/kg. The average mean artery pressure was（5.7 ±0.6） kPa,and the urine volume was（ 12.1 ± 5.7） mL/kg. In this group, the average CPB time was（76.2 ± 36.4） min, and the average intubation time was（55.7 ± 45.3 ） h and the duration of in-hospital was（ 12.7 ± 6.5 ） days. All infants survived. Conclusions Reasonable implementation of CPB management strategy, can guarantee the successful completion of cyanotic children in the beating heart with palliative right ventricle-pulmonary artery connection operation, and effectively reduce the incidence of postoperative complications.