新生儿完全性肺静脉异位连接的心肺转流管理体会

Management of cardiopulmonary bypass in neonates with total anomalous pulmonary venous connection

目的总结新生儿完全性肺静脉异位连接(TAPVC)心肺转流(CPB)的特点及管理。方法选取2014年1月至2018年8月在全麻CPB下行TAPVC矫治的新生儿共61例,其中心上型31例,心下型13例,心内型15例,混合型2例。中位年龄12.4(4.25,17.0)d,平均体重(3.2±0.59)kg,其中体重小于3 kg的有21例。53例存在不同水平的肺静脉回流受限。结果CPB时间44~271 min,升主动脉阻断时间为20~93 min;术后44例留置起搏电极,7例延迟关胸,9例行一氧化氮治疗,15例留置腹膜透析管。术后早期1例因低心排血量综合征死亡。结论新生儿TAPVC的CPB管理,特别是左心室小的新生儿管理,维持容量平衡、维持转流中胶体渗透压稳定,延长开放后辅助时间及梯度减低流量,对手术的结局和病患的安全有着非常重要的作用。

Objective To summarize the characteristics and management of cardiopulmonary bypass(CPB)in neonates with total anomalous pulmonary venous connection(TAPVC).Methods A total of 61 neonates from January 2014 to August 2018 were enrolled.The correction of TAPVC was performed under general anesthesia and CPB in all patients,with 31 cases of supracardiac type,13 cases of cardic type,15 cases of intracardiac type,and 1 case of mixed type.The median age was 12.4 days(range,4.25 to 17 days),and the median weight was 3.2 kg(2.8,3.6)with 21 case less than 3 kg.There were 53 cases of pulmonary venous insufficiency with different levels.Results CPB time was(44-271)min,aortic clamping time was(20-93)min.Fourty four patients were placed with pacing electrodes,7 patients had delayed chest closure,9 patients underwent NO therapy,and 15 patients underwent peritoneal dialysis.One patient died of low cardiac output syndrome in the early period of postoperation.Conclusion CPB management in neonates with TAPVC,especially in those with small left ventricular,prolonging post-opening assist time and reducing flow volume gradiently are very important for the outcome of operation and the safety of patients.