高原地区先天性心脏病合并肺动脉高压体外循环对策

Countermeasure of cardiopulmonary bypass for congenital heart disease complicated with pulmonary hypertension in plateau

目的 总结高原地区先天性心脏病 (先心病 )合并肺动脉高压 (肺高压 )的体外循环处理对策。方法 回顾性分析 2 0 0 1年 6月～ 11月在海拔 370 0m高原地区为先心病合并肺高压的体外循环手术病儿 36例 ,其中藏族 2 4例 ,世居西藏的汉族 12例。术前经超声心动图检查存在轻度肺高压 17例、中度 8例、重度 11例。体外循环采用浅低温和轻度血液稀释 ,预充液中均加入 2 0 %白蛋白及 3～ 5mg/kg地塞米松 ,转流中采用微量输液泵持续给予 5 %碳酸氢钠 ,全组均使用超滤或改良超滤技术。结果 体外循环时间 2 1～ 72min ,主动脉阻断时间 2 8～ 5 4min ;血气、电解质监测结果在正常范围 ;停机后全组病儿肺动脉压均有不同程度降低 ,由术前平均 (36 8± 10 4 )mmHg下降到停转流时 (2 9 4± 5 7)mmHg (P <0 0 5 ) ,以术后 2 4h降低最明显 ;全组均实现早期拔管 ,术后早期全部生存。结论 在高原地区除常规麻醉用药、手术矫正畸形及术后药物纠正肺高压外 ,在体外循环中增加胶体预充、应用大剂量激素、持续给予碳酸氢钠及使用超滤技术 ,能够取得满意的临床效果。

Objective: To study the countermeasure of cardiopulmonary pass (CPB) for congenital heart disease pulmonary hypertension (PH) in plateau areas. Methods: Thirty-six patients with congenital heart disease associated with PH underwent open-heart surgery under extracorporeal circulation from June 2001 to November 2001. Severe PH was found in 11 patients moderate PH in 8 and mild PH in 17. All patients had hypoxemia and acidosis. Priming is with ringer's, 20 percent protein and high dose of glucocorticoid. Beating heart with warm CPB was used in 20 cases and the hearts were arrested in 16 cases. During CPB, 5% NaHCO_3 was administered continuously at 10～30 ml/h adjusted according to ABG results. Ultrafiltration and modified ultrafiltration was used in all patients. Results: The duration of CPB ranged from 21 to 72 minutes and the aorta was cross-clamped from 28 to 54 minutes. Blood gas results were normal. The pulmonary artery pressure dropped after CPB. The mean pulmonary artery pressure was decreased from (36.8±10.4) mm?Hg to (29.4±5.7) mm?Hg, and reached its lowest level postoperatively. There was no operative death. Conclusion: Open-heart surgery can be performed safely in plateau areas with good results. Modified CPB method should be considered under this special condition.