新生儿心脏手术应用负压辅助静脉引流技术初探

Application of Vacuum Assisted Venous Drainage in Heart Surgeries for Newborns

目的探讨新生儿先天性心脏病手术过程中采用负压辅助静脉引流（VAVD）技术进行体外循环的有益尝试。方法 15例新生儿先天性心脏病患者,男性11例、女性4例,年龄2～28 d,平均（15.67±2.22）d,体重2.3～4.8 kg,平均（3.75±0.19）kg,胸骨正中切开常规建立体外循环,全组患儿在体外循环过程中均使用VAVD技术。结果全组病例15例,体外循环时间50～343 min,平均（170.3±26.6）min,主动脉阻断时间20～172 min,平均（85.8±14.6）min,全组术中无肉眼血尿,无引流不畅,无腔静脉插管困难,均顺利停机,无负压产生微气栓导致的神经系统并发症,无术后腔静脉梗塞、血栓形成等并发症,1例术后死亡,1例自动出院。结论 VAVD技术操作简便且费用低廉,比较安全有效,合适的负压可以使血液克服较细静脉插管阻力,加快血液引出速度,保证良好腔静脉引流和适当的灌注流量,减少预充量,为新生儿手术顺利进行保驾护航。

Objective To explore the role of cardiopulmonary bypass（ CPB） with vacuum assisted venous drainage（ VAVD） in the management of newborns with congenital heart diseases. Methods Total 15 newborns with congenital heart diseases（ 11 males and 4 females） underwent heart operations. Their age ranged from2 days to 28 days [mean：（ 15. 67 ± 2. 22） days],and their body weight from 2. 3 kg to 4. 8 kg [mean：（ 3. 75 ±0. 19） kg]. Sternal median incision was made to establish CPB,during which VAVD was applied for all the newborns. Results In these 15 newborns, the mean CPB time was from 50 minutes to 343 minutes [mean：（ 170. 3 ± 26. 6） minutes],and the mean aortic clamping time ranged from 20 minutes to 172 minutes [mean：（ 85. 8 ± 14. 6） minutes]. No macroscopic hematuria,inadequate drainage,or cannulation vena cava difficulty was observed during the procedures. All the newborns were successfully weaned from the machine. No neurological complication due to micro air embolus caused by negative pressure was noted. No vena cava infarction,thrombosis,or other complication was reported after the surgery,although one patient died after the surgery and another patient was discharged upon its family＇s own decision. Conclusions VAVD is a safe,simple,and cost-effective technique. Appropriate negative pressure can the resistance during thinner venous intubation and thus speed up blood drainage,provide adequate perfusion flow,and reduce the pre-filling volume.