主动脉弓离断矫治术的体外循环管理特点

Management of cardiopulmonary bypass in surgical repair of interrupted aortic arch

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.