摘要
目的对160例小于10公斤婴幼儿体外循环(CPB)下,先心病直视手术的临床工作进行总结。方法本组采用高灌注流量为主。129例为中度低温,12例复杂先心病应用深低温灌注技术,8例合并重度肺高压的婴幼儿利用氧合血持续肺灌注。32例应用常规超滤、平衡超滤或改良超滤,以减少组织细胞间隙水肿和炎性反应。本组采用全胶体、去白细胞库血及抑肽酶预充,转中红细胞压积(Hct)多在25%左右;术中持续进行各项监测。结果死亡14例,占总数的8.75%。并发症36例,包括心律失常、低氧血症、肾功能衰竭、肺不张、肺部感染等。结论CPB中要有良好平稳的灌注技巧;保持内环境平衡和有效的循环灌注压力;婴幼儿CPB应以高流量灌注为主,复跳后要有足够的后辅助循环时间,合理、及时、可靠的使用血管活性药物,有利于心功能的恢复。CPB预充应为全胶体并充分利尿,结合超滤技术以减少组织间隙水肿及炎性反应。采用有效的肺保护措施,包括去白细胞血液制品、药物保护、肺氧合血灌注保护、膜肺的应用等,可减轻全身炎性反应及灌注肺的发生。
OBJECTIVE To Summarize the management of CPB of 160 cases with body weight less than 10 kg. METHODS The way of perfusion is high^rate flow mainly. The study included 129 with moderate hypothermia, 12 with deep hypothermia and low flow (DHLF), 8 with continuously perfusion in main pulmonary for patients with severe PH during the CPB; 32 with conventional or modified ultra-filtrating(CUF, MUF). The solution for prime were full-colloid and Aprotinin and leukocyte depleted.HCT maintains about 0.25; the pump pressure and HCT and blood gas were monitored continuously during CPB.RESULTS 14 cases were died with a mortality rate of 8.74%. The complications were in 36 cases including arrhythmia, hypoxemia, pulmonary hypertension crisis, renal failure, atelectasis and pulmonary infection. CONCLUSION The key for a better perfusion include skillful perfusion technique, effective prime pressure, adequate diuretic usage and appropriate high flow rate. Full-colloid prime solution for all patients and utilizing appropriate protection of lung (leukocyte depleted blood production, continuously perfusion in main pulmonary, membrane oxygenator) also are important.
出处
《中国体外循环杂志》
2005年第2期113-115,104,共4页
Chinese Journal of Extracorporeal Circulation
关键词
体外循环
超滤
肺保护
Cardiopulmonary Bypass
Ultra-filtrating
Lung protection for lung's function
