深低温低流量体外循环下动脉导管缝扎术

Surgical-closure of patent ductus arteriosus under deep hypothermic low-flow perfusion cardiopulmonary dypass

目的 探讨深低温低流量体外循环下动脉导管缝扎术的手术方法和效果。方法 86例粗大的动脉导管、成人动脉导管或动脉导管合并其他心内畸形的病人 ,采用体外循环下降温至 2 1℃ ,低流量下缝扎动脉导管。结果 手术死亡 2例 ,死亡原因为术后低心排和肺动脉高压危象 ,存活 84例无脑栓塞、肾功能衰竭或其他神经系统并发症发生 ,随访 12～ 5 0个月无复发再通。结论 深低温低流量下动脉导管缝扎术对于粗大动脉导管、成人动脉病人是一种安全、可靠的手术方法。

Objective To summarize the experience of surgical closure of patent ductus arteriosus(PDA) under deep hypothermic low-flow perfusion cardiopulmonary bypass(CPB).Methods 86 cases of patients with large-size PDA,PDA of older age and PDA coexistence with other heart defect were surgically treated under deep hypothermic low-flow CPB.Median sternotomy was done and CPB was instituted.When the temperature was decreased to 21℃,pump flow was reduced to 10 ml·kg -1 ·min -1 ,PDA was closed using direct sutures or patch closure.Results Two patients died after operation,but no death was primarily related to CPB.Among them,one patient had low output syndrome after repairment of tetralogy of fallot,the other died from pulmonary hypertension.No brain or renal complication was reported in this series of patients.Conclusion Surgical closure of PDA under deep hypothermic low-flow perfusion CPB is safe.