摘要
目的探讨主动脉弓离断(IAA)矫治术的体外循环(CPB)管理方法。方法 2008年1月至2016年1月收治IAA患儿9例,其中男6例,女3例;手术年龄5 d^3岁,体重2.6~12.5 kg;其中IAA分型A型6例、B型3例。均在深低温停循环(DHCA)下完成IAA一期矫治及其合并的其它心脏畸形纠治术。结果 9例均采用DHCA,其中有6例在DHCA的基础上进行选择性顺行脑灌注(SACP),有3例未进行选择性脑灌注。平均转流时间(212±60)min,平均阻断时间(118±63)min,平均DHCA时间(27±4)min,平均选择性脑灌注时间(17±9)min;平均辅助时间(71±20)min。9例患儿均于术后24内清醒,呼吸机辅助时间10.2(0.58~18.07)d,ICU时间18(8~27.28)d,住院时间28(7~53)d。1例患儿术后第七天死于呼吸循环衰竭,其余8例患儿均康复出院。结论在DHCA下行婴幼儿IAA一期矫治术,停循环期间应采用持续SACP,且尽量缩短停循环时间。
Objective To summarize the clinical management and experience of cardiopulmonary bypass (CPB) in surgical repair of interrupted aortic arch (IAA). Methods Stage I repair was performed on 9 patients ( male 6, female 3) with interrupted aortic arch under deep hypothermic CPB from 2008 and 2016. The patients' age was 5 day to 3 years and body weight was 2.6 to 12.5 kg. Six patients had type A IAA and three patients had type B IAA. Results Deep hypothermia circulatory arrest (DHCA) was used in all cases. Selective antegrade cerebral perfusion (SACP) was performed in 6 patients. Mean duration of bypass was (212±60)min, mean cross-clamping time was (118±63) min, duration of DHCA was (27±4) min, duration of SACP was (17±9) min, and the continuous CPB time after cross-clamping removal was (71±20) min. All patients became awake within 24 hours postoperatively. The mean of mechanical ventilation time was 10.2(0.58-18.07) days, ICU time was 18 (8-27.28) days, and hospitalization time 28 (7-53) days. One patient died of respiratory and circulatory failure on postoperative day 7, and the other 8 patients recovered and were discharged uneventfully. Conclusion The one-stage repair of IAA in infants needs deep hypothermia CPB. The cerebral protection should be done with continuous cerebral perfusion and the shortening of duration of circulatory arrest.
出处
《中国体外循环杂志》
2016年第3期162-164,140,共4页
Chinese Journal of Extracorporeal Circulation
基金
四川省科技厅科技支撑项目(编号2012FZ0123)
关键词
主动脉弓离断
体外循环
深低温停循环
选择性脑灌注
Interrupted aortic arch
Cardiopulmonary bypass
Deep hypothermia circulatory arrest
Selective antegrade cere- bral perfusion