摘要：目的 探讨主动脉弓中断(IAA)矫治术中体外循环方法。方法 IAA患儿8例，男4例，女4例；年龄1m~2岁，体重3~8.3kg；其中A型4例，B型4例。均在深低温体外循环下一期矫治IAA及其合并心脏畸形。除早期1例采用单根主动脉灌注外，其余均采用上下半身同时灌注。早期2例采用α稳态血气管理，后期采用pH稳态和α稳态相结合的血气管理方式。结果 深低温停循环(DHCA)5例，深低温低流量(DHLF)2例， DHCA与DHLF相结合1例。平均转流时间(130±13)min，平均阻断时间(72±10)min,平均DHCA时间(34.5±10.2)min。死亡1例，神经系统并发症2例。结论 婴幼儿IAA宜在深低温体外循环下一期矫治，转流中采用持续脑灌注、控制停循环时间、pH稳态和α稳态相结合的血气管理等措施减少神经系统并发症。

    关键词：主动脉弓中断;体外循环;脑保护

    Management of Cardiopulmonary Bypass in the One-stage Repair of Interrupted Aortic Arch

    ZHOU Cheng-bin，ZHANG Xiao-hua，CHEN Ping, LUO Zhi-chao，ZHUANG Jian，CHEN Xin-xin

    (Department of cardiac surgery, Guangdong Provincial cardiovascular institute, Guangzhou, 510080)

    Abstract: OBJECTIVE To summarize the clinical experience of cardiopulmonary bypass (CPB) in the surgical repair of interrupted aortic arch (IAA).METHODS Eight patients (male 4, female 4) with IAA underwent one-stage repair with deep hypothermic CPB between February 2001 and November 2003. The operative age was 1 month -2 years and body weight was 3~8.3 kg. Four patients were IAA type A and four patients were IAA type B. All patients underwent whole body perfusion with two arterial cannulae except one patient using single arterial cannula. Alpha stat blood gas management was used in the early two patients. Alpha stat and pH stat blood gas management was applied in the rest.RESULTS Five patients underwent deep hypothermic circulation arrest (DHCA), two patients used deep hypothermic low flow (DHLF), and one patient underwent DHCA and DHLF. Mean duration of bypass was (130±13)min, mean cross-clamping time was (72±10)min and duration of DHCA was (34.5±10.2) min. Two patients had neurological complication. One patient died as the result of severe heart failure on postoperative 1 day.CONCLUSION The one-stage repair of IAA in infants needs deep hypothermia CPB. The cerebral protection must be done with continuous cerebral perfusion, the shortening of duration of circulatory arrest and blood gas management during bypass. ......