摘要：目的 探讨婴儿心脏直视手术的心肌保护特点。方法 回顾我院1990~2002年婴儿心脏直视手术496例的心肌保护情况，对其心肌保护方式进行分析评价。结果 29例未行主动脉阻断(ACC)，其余467例ACC时间7～199(49.0±30.5)min。ACC组中457例行冷晶体停搏液灌注；406例灌注1次；462例顺行灌注。升主动脉开放(CCR)后，自动复跳456例，电击复跳8例，起搏复跳3例。45例婴儿室间隔缺损修补术分组对照研究显示，灌注压力为45mmHg时心肌保护效果最佳。53例术后出现低心排综合征(LCOS)，紫绀型先心病LCOS发生率为26.2%(33/126)，显著高于非紫绀型及手术总LCOS发生率P<0.05。LCOS组年龄、体重、CCR时灌注流量、CCR时温度显著低于无LCOS组，ACC时间显著长于无LCOS组(P<0.05)；心律失常组年龄、体重、CCR时灌注流量、CCR时温度显著低于无心律失常组，ACC时间显著长于无心律失常组(P<0.01)。结论 冷晶体停搏液一次性顺行灌注能满足大多数婴儿心脏手术的要求；监控停搏液灌注过程中的压力十分必要；重视广义的心肌保护；LCOS及心律失常易发生于低年龄、低体重、ACC时间长的患儿，这类患儿是心肌保护的重点；对于心脏畸形复杂的手术，尤其紫绀型先心病，心肌保护有待进一步改善。

    关键词：婴儿;心脏直视手术;心肌保护

    Myocardial Protection in Infants Undergoing Open Heart Surgery-Analysis of 496 cases

    CHEN Ping, ZHANG Jing-fang, ZHANG Xiao-hua, ZHUANG Jian, CHEN Xin-xin

    (Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute,Guangzhou 510100, China)

    Abstract: OBJECTIVE To retrospect the myocardial protection during open heart surgery on infants.METHODS From 1990 to 2002, 496 infants underwent open heart surgery in our department. This article reviews the methods of myocardial protection RESULTS 29 cases underwent beating heart procedure without aortic cross clamping(ACC). Other 467 cases with cardioplegia arrest had a ACC duration of 7~199(49.0±30.5)min. Among 467 cases with ACC, cold crystalloid cardioplegia was adopted in 457cases, cardioplegia was delivered only once in 406 cases, antegrately in 462 cases. After cross-clamping release (CCR), in 456 cases heart beat returned spontaneously, 8 cases with electric shocks, 3 cases with pacing. As to cardioplegia delivery pressure, a comparision among 45 cases undergoing reparing of pure ventricular septum defect suggested 45 mmHg seemed to afford best myocardial protection. Postoperative low cardiac output syndrome (LCOS) occured in 53 out of 496 cases. The LCOS incidence of cyanotic infants is 26.2%, higher than non-cyanotic ones and total infants incidences (P<0.05). Age, body weight, CCR temperature and flow rate in LCOS group were lower than in no LCOS group, and ACC duration in LCOS group was longer than in no LCOS group (P<0.05). Age, body weight, CCR temperature were lower and ACC duration was longer in arrhythmia group than in no arrhythmia group(P<0.01).CONCLUSION Cold crystalloid cardioplegia delivery only once can full fill the need of most infant open heart operations; Supervising and controlling the pressure of cardioplegia delivery is necessary and important; Attentions must be paid to general myocardial protection in broader sense; LCOS and arrhythmia easy occur in infants with younger age, lower body weight and longer ACC duration; For operations of complex heart disease, especially cyanotic congenital heart diseases, myocardial protection needs further improvement . ......