摘要
目的 :总结 2 0 0 2年 7月至 2 0 0 3年 6月 5kg以下婴儿体外循环经验。方法 :5 3例先心病患儿 ,手术年龄 (1 93± 1 60 )月 ,体重 (3 89± 0 70 )kg。使用StockertⅢ人工心肺机、Dideco90 1膜肺和MinntechHPH 40 0血液浓缩器。中低温高流量灌注 3 1例 ,深低温低流量 (DHLF) 11例 ,深低温停循环 (DHCA) 9例 ,常温体外循环 2例。心肌保护采用改良St .Thomas停搏液经主动脉根部单次灌注。常规使用超滤技术。结果 :体外循环转流时间 (10 9 2±69 2 )min ,主动脉阻断 (62 1± 46 4)min。复杂心脏畸形手术均在深低温体外循环下进行。转流中红细胞压积(Hct)为 (2 6 0± 2 7) % ,超滤完毕Hct达 (3 3 5± 3 6) % ,超滤量为 (2 90± 14 3 )mL。死亡 6例 ,均为大血管转位的患儿。结论 :根据病情和手术要求采取不同的体外循环方式 ,减少预充量 ,开展超滤技术 ,加强心肌保护和脏器保护是提高体外循环安全性的重要保证。
Objective To review the experience of cardiopulmonary bypass in infant weighting less than 5kg from July 2002 to June 2003. Methods Fifty three infants were (1 93±1 60)month old and weighted (3 89±0 70)kg. The apparatus of bypass included Stckert Ⅲ heart lung machine, Dideco901 oxygenator and Minntech HPH400 blood concentration. There were 31 cases with moderate hypothermia high flow rate, 11 cases with deep hypothermic low flow rate, 9 cases with deep hypothermic circulatory arrest, and 2 cases with normothermia high flow rate. St. Thomas' cardioplegic solution infused into the root of aorta with single dose. Ultrafiltration was used for every case. Results Duration of cardiopulmonary bypass was (109 2±69 2)min,clamping time was (62 1±46 4)min. The complex cardiac deformity was corrected under deep hypothermia. The volume of water removed by ultrafiltration was (290±143)mL, Hematocrit reached to (33 5±3 6)% after ultrafiltration. Six cases with transposition of great arteries died. Conclusion The appropriate bypass was chosen according to the case and operational situation. It is important that low prime volume, ultrafiltration, myocardial preservation and cerebral protection in infant cardiopulmonary bypass.
出处
《实用医学杂志》
CAS
2004年第1期24-25,共2页
The Journal of Practical Medicine
