肺血少型小体质量婴儿心脏直视手术体外循环管理

Management of cardiopulmonary bypass for open heart surgery of infants with low weight and decreased pulmonary artery blood flow

目的探讨肺血少型小体质量婴儿先天性心脏病心内直视手术的体外循环(CPB)管理策略,以促进患儿恢复,减少术后并发症。方法对38例体质量<5 kg的先心病心内直视手术婴儿,实施浅、中低温CPB,术中零平衡超滤结合术后改良超滤。回顾性分析患儿CPB资料。结果开放主动脉后心脏自动复跳34例,无严重心律紊乱。术后所有患儿均顺利脱离体外循环,无严重CPB并发症。结论肺血少型小体质量婴儿,CPB小剂量预充,术中较高的血球压积和胶体渗透压,与温度良好匹配的流量,完善的心肺等器官保护,以及超滤是减少CPB术后并发症,促进患儿术后顺利恢复的有效措施。

Objective To improve the management strategy for the infants with low weight and decreased pulmonary artery blood flow undergoing cardiopulmonary bypass（ CPB）. Methods The clinical data of 38 infants including age,body weight,operation type and CPB conditions including equipment,composition of priming liquids,duration of CPB and clamping time of ascending aorta were retrospectively analyzed,who were less than 5 kg in body weight and underwent CHD operations. The infants aged 20 days to 8 months,weighed 2. 6 ~ 5. 0 kg. All cases used mild hypothermia and moderate hypothermia,Modified ultrafiltration（ MUF） and Balanced ultrafiltration（ BUF） was used in all patients. Results After cross clamping release,heart beat recovered spontaneously in 34 patients without severe arrhythmia. 38 cases were successfully weaned from CPB without severe complications. Conclusion Appropriate infant bypass,low prime volume,keeping high HCT and colloidal pressure adapted perfusion flow rate matching temperature,myocardial preservation and pulmonary protection during CPB,MUF and BUF can lead to good results.