体外循环不阻断升主动脉小儿心内直视术312例临床分析

Open heart surgery without aortic-cross clamping under cardiopulmonary bypass in infants

目的 评价体外循环下不阻断升主动脉行心内直视术对小儿心肌的保护作用。方法 回顾性分析 1995年 9月至 2 0 0 1年 6月 ,312例应用此法手术的小儿先天性心脏病病例。全组男 16 0例 ,女15 2例。平均年龄 (3 2 5± 1 34)岁。平均体重 (14 6 1± 3 72 )kg。病种包括室间隔缺损、房间隔缺损、法洛四联症、法洛三联症、房室通道、部分性肺静脉畸形引流、肺动脉瓣狭窄、三房心和三尖瓣下移。在浅低温心脏跳动下手术 2 13例 ,中低温停跳下手术 99例。结果 全组无脑气栓发生。随访 2～ 36个月。术后出现低心输出量综合征 6例、支气管痉挛 3例、肾功能衰竭 2例、血红蛋白尿 32例。全组死亡 7例(2 2 4 % )。结论 不阻断升主动脉 ,浅、中低温体外循环心脏停跳或不停跳下心内直视术 ,用于小儿先天性心脏病矫治 ,心肌保护安全有效 。

Objective: To evaluate the effect of no aortic lamping on myocardiac protection under cardiopulmonary bypass(CPB) during open heart surgery. Methods: From Sep.1995 to Jun.2001, 312 infants with congenital heart malformations underwent open heart surgery using the technique of no aorta clamping under CPB. They were 160 boys and 152 girls. Their age ranged from 3 months to 5 years [mean (3 25±1 34) years]. Body weight ranged from 5 to 20 kg [mean (14 61±3 72) kg]. The congenital heart malformations included: ventricular septal defects in 237, atrial septal defects in 31, tetralogy of Fallot in 27, trilogy of Fallot in 4, atrioventricular canal in 5, partial anomalous pulmonary venous connection in 3, pulmonary stenosis in 3, cor triatriatum in 1 and Ebstein's malformation in 1. Open hear surgery was performed under mild hypothermic CPB with beating heart in 213 patients, and under moderate hypothermic CPB with cardiac arrest in 99.Results: All infants were followed up from 2 months to 3 years. Postoperative complications were low cardiac output syndrome in 6, bronchial spasm in 3, renal insufficiency in 2, and hemoglobinuria in 32. No cerebral embolism was found. There were 7 operative deaths with a mortality rate of 2.24%. Conclusion: Open heart surgery without aortic cross clamping in infants is a feasible, effective and safe technique for myocardial protection during CPB.