低龄、低体重先天性心脏病患儿体外循环管理体会

Experience in management of cardiopulmonary bypass in low-age and low-weight children with congenital heart disease

目的探讨低龄、低体重先天性心脏病患儿在心内直视手术中的体外循环管理方法。方法收集2016年12月至2018年6月68例低龄、低体重先天性心脏病患儿进行心内直视手术的体外循环资料,观察分析体外循环转流时间、升主动脉阻断时间、转中尿量、平均滤液、呼吸机辅助时间、胸腔引流量和死亡病例等情况。结果全组患儿均顺利完成手术,均顺利脱离体外循环,术后呼吸机辅助时间6~72h,24h胸腔引流量25~200mL,术中及术后近期无死亡病例,未发现与体外循环有关的并发症。结论低龄、低体重和各脏器发育未成熟是婴幼儿心内直视手术的主要风险因素;合理预充处理,合理的灌注方法,合理使用超滤方法等可有效提高婴幼儿ECC管理的质量。

Objective To explore the management method of cardiopulmonary bypass for Experience in management of cardiopulmonary bypass in low-age and low-weight children with congenital heart disease children with congenital heart disease of during open heart surgery.Methods From December 2016 to June 2018,data on cardiopulmonary bypass of 68 low-age and low-weight children with congenital heart disease undergoing open heart surgery were collected.Cardiopulmonary bypass time,ascending aorta occlusion time,transfer urine volume,average filtrate,ventilator assist time,chest drainage,and death cases were observed and analyzed.Results All children in the whole group were successfully completed the operation,and were successfully separated from the cardiopulmonary bypass.The postoperative ventilator assisted time was 6 to 72 hours,and the 24-hour thoracic drainage volume was 25 to 200 mL.There were no deaths and complications during and shortly after the operation.Conclusion low-age,low-weight,and immature development of various organs are the main risk factors for infant heart surgery.Reasonable pre-filling treatment,reasonable perfusion method,and rational use of ultrafiltration methods can effectively improve the quality of infant ECC management.