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5kg以下婴儿一期矫治主动脉缩窄合并心内畸形的体外循环管理 被引量:6

Management of Extracorporeal Circulation in One Stage Repair of Aortic Coarctation with Intracardiac Defects in Infants Less Than 5 kg in Weight
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摘要 目的总结5kg以下婴幼儿经胸骨正中切口一期矫治主动脉缩窄(CoA)合并心内畸形的体外循环(ECC)方法及临床经验。方法回顾性分析华中科技大学同济医学院附属协和医院2008年7月至2012年6月一期矫治CoA合并心内畸形35例患儿,男28例,女7例,年龄1~6(2.9±1.3)个月,其中小于3个月21例,体重2~5(4.1±0.9)kg,全部病例均经胸骨正中切口在深低温停循环(DHCA)结合选择性顺行脑灌注(SACP)下行主动脉弓重建。麻醉诱导后建立上、下肢动脉压监测,鼻咽温、肛温监测。体外循环开始后逐级降温至肛温25℃,鼻咽温22℃~23℃时停体外循环。通过将主动脉插管移至无名动脉进行SACP,流量25~35mL/(kg.min)。主动脉弓重建完成后恢复主动脉插管,充分排气后全身灌注。全组病例均使用零平衡超滤+改良超滤技术。结果 ECC时间115~138(126.2±10.3)min,主动脉阻断36~68(44.1±4.5)min,SACP时间28~49(33.3±2.7)min。死亡1例,于术后9d死于严重的肺部感染。2例术后出现急性肾功能不全,经腹膜透析后恢复,全组患儿均无与ECC相关的中枢神经系统并发症。结论 5kg以下婴儿行一期矫治CoA合并心内畸形术中,使用DHCA结合SACP方法,采用"改良的"pH-稳态血气管理,合理血液稀释,零平衡超滤+改良超滤技术等综合保护策略有助于重要器官的保护,尤其是减少了术后中枢神经系统并发症的发生率。 Objective To examine the management and summarize the experience of extracorporeal circulation(ECC) in one stage repair of aortic coarctation with intracardiac defects in infants less than 5 kg in weight. Methods One stage repair was performed in 35 infants with aortic coarctation and intracardiac defects from July 2008 to June 2012. The infants included 28 males and 7 females,with their age ranging from 1 - 6 (2.9 ± 1.3) months. Twenty-one patients were aged less than 3 months and had a weight of 2- 5 (4.1 ± 0.9) kg. Deep hypothermic circulatory arrest (DHCA) combined with selective antegrade cerebral perfu- sion(SACP) was applied during reconstruction of the aortic arch. After anesthesia induction,lower limb arterial pressure moni- toring was performed, as well as nasopharyngeal and rectal temperature monitoring. When the rectal temperature was cooled down to 25℃ or the nasopharyngeal temperature between 22℃-23℃, the aorta intubation tube was moved to the innominate artery,and perfused in a flow of 25-35 mL/(kg · min). After aortic arch reconstruction,the aorta intubation and systemic per- fusion were stopped. Zero balance ultrafiltration plus improved ultrafiltration technology was used in all cases. Results The ECC time lasted 115-138(126.2±10.3) min with aortic arrest time of 36-68(44.1±4.5) min and SACP time of 28-49 (33.3 ± 2.7) min. One infant died from serious lung infection after operation. Two infants were given peritoneal dialysis and re- covered. No complications correlated with central nervous system occurred. Conclusion In aortic arch reconstruction for infants with aorta coarctation and intracardiac defects,the comprehensive application of DHCA and SACP is safe and feasible for the protection of the important organs, especially for reducing postoperative complications of the central nervous system.
出处 《华中科技大学学报(医学版)》 CAS CSCD 北大核心 2013年第2期234-236,共3页 Acta Medicinae Universitatis Scientiae et Technologiae Huazhong
关键词 婴儿 主动脉缩窄 体外循环 infant aorta coarctation extracorporeal circulation
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