先天性主动脉瓣上狭窄的心肺转流管理经验

Cardiopulmonary bypass management of congenital supravalvular aortic stenosis

目的回顾性总结先天性主动脉瓣上狭窄的心肺转流(CPB)管理经验。方法 2009年01月至2019年10月,20例先天性主动脉瓣上狭窄的患者在CPB下行手术治疗,术中运用浅低温下CPB,选择合适的插管、维持合适的灌注压、术中用HTK液心肌保护及加强血液保护的管理方法。结果 20例主动脉瓣上狭窄患者死亡3例,存活率85%,CPB时间(116.77±39.85)min,主动脉阻断时间(62.31±22.15)min,心脏自动复跳14例,余6例经电除颤后恢复自主心跳,除1例在ECMO辅助下脱机外,其余患者顺利脱离人工心肺机。2例患者因术后发生低心排血量综合征死亡,1例出现重症感染,随后多器官功能衰竭最终死亡,其余患者恢复良好,顺利出院。结论术中选择合适的插管,维持较高的灌注压、加强心肌保护及良好的血液保护的CPB管理可以为先天性主动脉瓣上狭窄手术提供重要保障。

Objective To retrospectively summarize the clinical experience of cardiopulmonary bypass management of congeni⁃tal supravalvular aortic stenosis.Methods From January 2009 to October 2019,20 cases of congenital supravalvular aortic stenosis underwent surgery with cardiopulmonary bypass.Mild hypothermia,appropriate cannulation and perfusion pressure,HTK solution of myocardial protection,and blood protection management were administrated during cardiopulmonary bypass.Results Among the 20 cases,3 patients died and the survival rate was 85%.The cardiopulmonary bypass time was(116.77±39.85)min,and the aortic crossclamp time was(62.31±22.15)min.14 cases showed automatic heart resuscitating while 6 cases needed defibrillation.Except one case was weaned with ECMO support,rest of the patients were weaned from cardiopulmonary bypass smoothly.Two cases died of low cardiac output postoperatively,one case suffered from severe infection,and then died of multiple organ failure.The mortality was 15%and rest of the patients recovered well and then discharged.Conclusion Cardiopulmonary bypass management measures including se⁃lecting appropriate cannulation,maintaining a high perfusion pressure,strengthening myocardial protection and blood protection provide important guarantees for the success of congenital supravalvular aortic stenosis surgery.