浅低温下连续心脑灌注在小儿主动脉缩窄手术中的应用

Mild hypothermic continuous cerebral and myocardial perfusion in pediatric aortic coarctation surgery

目的比较浅低温连续心脑灌注和中低温顺行脑灌注两种转流方法下进行小儿主动脉缩窄(CoA)纠治手术的临床应用效果。方法总结54例CoA合并室间隔缺损、房间隔缺损、动脉导管未闭的患儿手术病例,根据灌注方法不同,分为心脑灌注组(n=20)和脑灌注组(n=34),对术中体外循环时间,主动脉阻断时间,CoA纠治时间,术后呼吸机插管时间,ICU时间,术后并发症及院内死亡率等情况进行分析。结果心脑灌注组的体外循环时间和主动脉阻断时间明显较脑灌注组短(P<0.05),在术后低心排率,腹透率和延迟关胸率方面,心脑灌注组均比脑灌注组低,但统计学无显著差异。结论连续心脑灌注,是主动脉弓手术中一项新的转流技术,相比顺行脑灌注,可以明显的减少冠脉的缺血时间,更好的保护心功能。

Objective To evaluate the effects of continuous cerebral and myocardial perfusion（CCMP） and antigrade cerebralperfusion（ACP） in pediatric aortic coarctation corrective surgery.Methods Fifty-four chirdren with CoA and other co-existing cardi-ac defect（s）such as VSD ASD PDAundergoing corrective surgery with CCMP（n= 20）or ACP（n= 34）were included in this study. Thebypass time, aortic clamp time, aortic coarctation repair time, ventilation time, ICU stay time and post-operative complications wererecorded and compared between two groups.Results The bypass time and aortic clamp time was shorter in CCMP group（P0.05）,and CCMP group had a lower morbidity rates in low cardiac output,delayed sternal closure and peritoneal dialysis post operatively.Conclusion Compared with antegrade cerebral perfusion, CCMP techniquecould reduce coronary ischemia time further, and providesuperior heart functionprotection in aortic coarctation corrective surgery.