改良CO_2术区充溢技术用于小儿先天性心脏病手术的效果初探

Modified Carbon Dioxide Field Flooding Technology During Operation for Congenital Heart Disease in Children

目的评估改良CO2术区充溢技术（CO2De-airing,CO2De-A）在小儿先天性心脏病心内直视手术中的排气效果及安全性。方法选取2013年6月-2014年1月我院心外科开胸手术45例,采用简单随机化分组法将入选病例分为3组,每组15例。A组术中应用CO2De-A和机械性手法排气,气体灌注速度为10 L/min;B组术中应用CO2De-A和机械性手法排气,气体灌注速度为5 L/min;C组机械性手法排气。全部手术为同一个医疗组实施,术者为同一名医生。主动脉开放后10min、体外循环停机前后5 min两个时段进行经颅超声多普勒探查脑膜中动脉的气泡数量,并由2名有经验的超声医师进行盲评记录。记录主动脉开放时、体外循环结束时的血Pa CO2。结果全部病例顺利完成治疗并出院,半年后复查无手术并发症。超声发现3个组于主动脉开放后均有气体在双侧脑膜中动脉出现,随手术进行,气体逐渐减少至消失。主动脉开放后10min内A组、B组气泡数量明显少于C组（16.50±4.12 vs.50.00±6.62,q=14.77,P=0.000;22.70±4.06 vs.50.00±6.62,q=12.04,P=0.000）,具有统计学意义。停体外循环前后5 min 3组气泡数量无统计学意义（F=0.719,P=0.496）。主动脉开放及停体外循环2个时间点3组间血Pa CO2差异无统计学意义。结论改良CO2De-A在小儿先天性心脏病开胸手术中可明显减少进入循环的气泡数量,未见高碳酸血症和酸中毒发生。

Objective To assess the efficacy and safety of carbon dioxide field flooding in open-heart operations for congenital heart disease in children. Methods A total of 45 children undergoing heart surgery in our hospital from June 2013 to January 2014 were randomly divided into 3 groups： 15 cases receiving CO2de-airing and mechanical de-airing with an inflation rate of 10 L / min（ group A）; 15 cases receiving same technique with an inflation rate of 5 L/min（ group B）; 15 cases receiving mechanical de-airing as control（ group C）. All patients were operated by the same surgeon and treated in the same medical group. The bubbles in middle meningeal artery were detected by trans-cranial Doppler and the number was recorded and blindly evaluated by two experienced ultrasound doctors. The value of Pa CO2 at the moment of open aortic and stop cardiopulmonary bypass was recorded for the assessment of body acid-base balance status. Results All the cases recovered well and there were no complications during a 6-months followups. In all three groups,amount of bubbles were detected by trans-cranial Doppler in double sides of middle meningeal arteries after open aortic and gradually decreased to disappearance. By comparison,the number of bubbles both in group A and group B was significantly less than that in the group C during 10 min after opening aorta（ 16. 50 ± 4. 12 vs. 50. 00 ± 6. 62,q = 14. 77,P = 0. 000;22. 70 ± 4. 06 vs. 50. 00 ± 6. 62,q = 12. 04,P = 0. 000）. However,no difference was seen among the three groups during 5 min before and after stopping cardiopulmonary bypass（ F = 0. 719,P = 0. 496）. The value of Pa CO2 had no difference among the three groups at the moment of opening aortic and stopping cardiopulmonary bypass. Conclusion The modified CO2 field flooding technique is effective to decrease the number of bubbles entering the circulation in the open-heart operations in children,without hypercarbia or acidosis.