153例10公斤以下婴幼儿心脏直视手术的体外循环管理(1)
[摘要] 目的 总结10公斤以下婴幼儿心脏直视手术的体外循环管理。 方法 2006年12月~2011年7月共对153例10公斤以下婴幼儿在体外循环下实施例心脏直视手术，男82例，女71例，年龄为5个月~5岁，平均(20.0±8.4)个月，其中5~12个月31例，13~24个月82例，25~36个月39例，37~60个月1例；体重4~10 kg，平均(8.9±1.3)kg。69例使用膜肺，84例使用西京87型(小号)鼓泡式氧合器；19例采用心脏不停跳下手术，其余均阻断升主动脉，灌注冷晶体心脏停搏液，浅或中低温高流量灌注。 结果 体外循环时间为18~166(57.5) min，主动脉阻断时间为8~123(39) min，开放主动脉后148例患儿心脏自动复跳，自动复跳率为97%，辅助时间为4~60(16) min。术后患儿死亡3例，死亡率为2%，死亡原因2例为严重低心排，1例为突然心脏骤停，抢救无效临床死亡。 结论 根据婴幼儿的体重、病情及手术操作难易程度选用膜肺或鼓泡肺，尽量减少预充晶体量，提高胶体预充量，采用高流量灌注，通过给予速尿、超滤、加入白蛋白提高胶体渗透压，排除体内多余水分及良好的心肌保护、肺保护、脑保护有利于患儿术后的恢复。
, http://www.100md.com
[关键词] 婴幼儿；心内直视手术；体外循环
[中图分类号] R726.1 [文献标识码] C [文章编号] 1673-7210(2012)04(a)-0186-03
Extracorporeal circulation of open heart surgery in infants with 153 cases weithed below 10kg management
SUN Weihong ZHANG Shudong ZHU Zhicheng XU Rihao WANG Tiance LIU Kexiang▲
Department of Cardiovascular, the Second Hospital of Jilin University, Jilin Province, Changchun 130041, China
, 百拇医药
[Abstract] Objective To summarize the extracorporeal circulation (ECC) management in infants weighted below 10 kg with open heart surgery. Methods 153 cases weighted below 10 kg with open heart surgery from December 2006 to July 2011, Male 82 cases, female 71 cases, age 5 months - 5 years on average (20±8.4) months, 5-12 months 31 cases,13-24 months 82 cases, 25-36 months 39 cases, 37-60 months 1 case; weight was 4-10 kg, the average was (20±1.3) kg, 69 cases with membrane oxygenator, 84 cases with Xijing 87 (small) bubbling oxygenator; 19 patients with beating heart surgery, the rest were aortic cross clamp (ACC), infusion of cold crystalloid cardioplegia, mild or moderate low temperature and high flow in the perfusion. Results The mean ECC times were 18-166 (57.5) min, aortic cross-clamping times were 8-123 (39) min, with the heartbeat recovered spontaneously in 148 cases after aortic clamping release (CCR), automatic beating rate was 97%, support time was 4-60 (16) min. 3 infants died after operation, the mortality rate of 2%, causes of death in 2 cases of severe low cardiac output, 1 case died of sudden cardiac arrest. Conclusion According to infant weight, condition and ease of use surgical operation bubbling oxygenator or membrane oxygenator to minimize the amount of priming, high flow perfusion, by giving Lasix, ultrafiltration, adding albumin colloid to improve osmotic pressure avoidance of fluid retention and favourable myocardial and lung also cerebral preservation, will helpful postoperative recovery
, http://www.100md.com
[Key words] Infants; Open heart surgery; Extracorporeal circulation
婴幼儿的生理解剖与成人大不相同，根据患儿自身的病理生理特点，建立适合于婴幼儿患儿非生理状态的体外循环过程，对提高患儿手术成功率及术后尽早恢复均具有重要意义[1]。我院2006年12月~2011年7月共对153例10公斤以下婴幼儿在体外循环下实施心脏直视手术，取得了较好的效果。现将术中体外循环(cardio pulmonary bypass，CPB)的管理总结分析如下：
1 资料与方法
1.1 一般资料
153例婴幼儿患儿中，男82例，女71例，年龄为5个月~5岁，平均(20.0±8.4)个月，其中5~12个月31例，13~24个月82例，25~36个月39例，37~60个月1例；体重4~10 kg，平均(8.9±1.3)kg。病种包括：室间隔缺损42例，室间隔缺损合并其他畸形62例，房间隔缺损13例，法洛四联症28例，部分型心内膜垫缺损1例，完全型心内膜垫缺损3例，右室双出口1例，肺静脉异位引流1例，主动脉瓣下隔膜1例，单心室大动脉转位1例。
, 百拇医药
1.2 体外循环设备器材及预充方法
全部患儿中有19例采用在常温下行心脏不停跳手术，其余均在全麻浅或中低温CPB停跳下行心脏直视手术。体外循环机为StockertS5和Sarns8000，其中69例使用Dideco902、 Terumo和MAQUET膜肺，84例使用西京87型(小号)鼓泡肺，全部采用普惠公司婴儿B型管道及婴儿型动脉微栓过滤器。常规预充复方乳酸林格氏液排气后，排掉多余乳酸林格氏液后，再根据患儿术前的平均红细胞压积(HCT)加入适量红细胞悬液(简称红悬)、血浆及20 mL 5%碳酸氢钠。一般非紫绀型先心患儿术前HCT维持在33%以下要全血预充红悬2单位，HCT维持在33%~40%预充红悬1单位、血浆200 mL，预计转机后HCT维持在15%~25%，但紫绀型先心病患儿术前HCT维持在40%以上，全血浆400 mL预充，转机后HCT控制在25%~30%[2]，所有患儿术前均不预充白蛋白。应用膜肺预充总液量为360~500 mL，应用西京87型(小号)鼓泡肺预充总液量为600~800 mL。, 百拇医药(孙卫红 张曙东 朱志成 许日昊 王天策 柳克祥)
, http://www.100md.com
[关键词] 婴幼儿；心内直视手术；体外循环
[中图分类号] R726.1 [文献标识码] C [文章编号] 1673-7210(2012)04(a)-0186-03
Extracorporeal circulation of open heart surgery in infants with 153 cases weithed below 10kg management
SUN Weihong ZHANG Shudong ZHU Zhicheng XU Rihao WANG Tiance LIU Kexiang▲
Department of Cardiovascular, the Second Hospital of Jilin University, Jilin Province, Changchun 130041, China
, 百拇医药
[Abstract] Objective To summarize the extracorporeal circulation (ECC) management in infants weighted below 10 kg with open heart surgery. Methods 153 cases weighted below 10 kg with open heart surgery from December 2006 to July 2011, Male 82 cases, female 71 cases, age 5 months - 5 years on average (20±8.4) months, 5-12 months 31 cases,13-24 months 82 cases, 25-36 months 39 cases, 37-60 months 1 case; weight was 4-10 kg, the average was (20±1.3) kg, 69 cases with membrane oxygenator, 84 cases with Xijing 87 (small) bubbling oxygenator; 19 patients with beating heart surgery, the rest were aortic cross clamp (ACC), infusion of cold crystalloid cardioplegia, mild or moderate low temperature and high flow in the perfusion. Results The mean ECC times were 18-166 (57.5) min, aortic cross-clamping times were 8-123 (39) min, with the heartbeat recovered spontaneously in 148 cases after aortic clamping release (CCR), automatic beating rate was 97%, support time was 4-60 (16) min. 3 infants died after operation, the mortality rate of 2%, causes of death in 2 cases of severe low cardiac output, 1 case died of sudden cardiac arrest. Conclusion According to infant weight, condition and ease of use surgical operation bubbling oxygenator or membrane oxygenator to minimize the amount of priming, high flow perfusion, by giving Lasix, ultrafiltration, adding albumin colloid to improve osmotic pressure avoidance of fluid retention and favourable myocardial and lung also cerebral preservation, will helpful postoperative recovery
, http://www.100md.com
[Key words] Infants; Open heart surgery; Extracorporeal circulation
婴幼儿的生理解剖与成人大不相同，根据患儿自身的病理生理特点，建立适合于婴幼儿患儿非生理状态的体外循环过程，对提高患儿手术成功率及术后尽早恢复均具有重要意义[1]。我院2006年12月~2011年7月共对153例10公斤以下婴幼儿在体外循环下实施心脏直视手术，取得了较好的效果。现将术中体外循环(cardio pulmonary bypass，CPB)的管理总结分析如下：
1 资料与方法
1.1 一般资料
153例婴幼儿患儿中，男82例，女71例，年龄为5个月~5岁，平均(20.0±8.4)个月，其中5~12个月31例，13~24个月82例，25~36个月39例，37~60个月1例；体重4~10 kg，平均(8.9±1.3)kg。病种包括：室间隔缺损42例，室间隔缺损合并其他畸形62例，房间隔缺损13例，法洛四联症28例，部分型心内膜垫缺损1例，完全型心内膜垫缺损3例，右室双出口1例，肺静脉异位引流1例，主动脉瓣下隔膜1例，单心室大动脉转位1例。
, 百拇医药
1.2 体外循环设备器材及预充方法
全部患儿中有19例采用在常温下行心脏不停跳手术，其余均在全麻浅或中低温CPB停跳下行心脏直视手术。体外循环机为StockertS5和Sarns8000，其中69例使用Dideco902、 Terumo和MAQUET膜肺，84例使用西京87型(小号)鼓泡肺，全部采用普惠公司婴儿B型管道及婴儿型动脉微栓过滤器。常规预充复方乳酸林格氏液排气后，排掉多余乳酸林格氏液后，再根据患儿术前的平均红细胞压积(HCT)加入适量红细胞悬液(简称红悬)、血浆及20 mL 5%碳酸氢钠。一般非紫绀型先心患儿术前HCT维持在33%以下要全血预充红悬2单位，HCT维持在33%~40%预充红悬1单位、血浆200 mL，预计转机后HCT维持在15%~25%，但紫绀型先心病患儿术前HCT维持在40%以上，全血浆400 mL预充，转机后HCT控制在25%~30%[2]，所有患儿术前均不预充白蛋白。应用膜肺预充总液量为360~500 mL，应用西京87型(小号)鼓泡肺预充总液量为600~800 mL。, 百拇医药(孙卫红 张曙东 朱志成 许日昊 王天策 柳克祥)