摘要
目的总结婴儿先天性心脏病手术体外循环(ECC)过程中联合应用负压辅助静脉引流及复合超滤的管理经验。方法回顾性分析2011年1月-2012年12月行先天性心脏病手术的72例10kg以下婴儿的临床资料,其中男42例,女30例,年龄14d～24个月(13.1±6.2个月),体重3.4～10(8.18±1.88)kg,简单先天性心脏病(房间隔、室间隔缺损)44例,复杂先天性心脏病(法洛四联症、部分型/完全型房室通道、右室双出口等)28例。体外循环均使用进口膜式氧合器(Terumo Baby-RX或Maquet VKMO 10000),常规应用乳酸林格液加人血白蛋白预充,预充液总量250～450ml。体外循环中流量90～150ml/(min·kg),维持血细胞比容0.20～0.30,平均动脉压35～50mmHg,肛温25～32℃。术中均采用HTK心脏停搏液行心肌保护。体外循环中常规使用负压辅助静脉引流,负压控制于-10mmHg至-30mmHg;常规应用复合超滤,即体外循环中使用常规超滤,停机后应用改良超滤。结果体外循环时间30～174(82.6±31.2)min,升主动脉阻断时间6～125(51.7±30.1)min。全部患儿在体外循环中末梢灌注良好,血气化验均在正常范围,心脏自动复苏率94.4%(68/72),顺利脱机。体外循环中常规超滤60～380ml,停机后改良超滤50～230ml,改良超滤结束时血细胞比容为0.32±0.11。术中输红细胞0.5～2.0(1.61±0.40)U,术后呼吸机辅助时间6～74(34.1±16.6)h,24h心包纵隔引流量70～410(115.6±75.8)ml。1例完全性房室通道患儿行房缺修补、二尖瓣成形术,术后因严重低心排、呼吸循环衰竭死亡,其余患儿均痊愈出院,总死亡率1.4%(1/72)。结论低体重婴儿心内直视术体外循环中应用负压辅助静脉引流结合复合超滤技术可以保证良好的静脉引流,最大限度地减少预充量,提供充分的灌注流量,有助于维持合理的内环境和血细胞比容。
Objective To summarize the managerial experiences in the application of combined ultrafiltration and vaccum-assisted venous drainage （VAVD） in extracorporeal circulation （ECC） for congenital heart diseases operation in infants. Methods The clinical data of 72 infants [42 males and 30 females, aged 14d to 24 months （13.1 ± 6.2 months）, body weight 3.4- 10（8.18 ± 1.88）kg], who underwent operation to correct congenital heart diseases from Jan 2011 to Dec 2012, were retrospectively analyzed. Forty-four of the 72 infants were suffering from simple congenital heart diseases （atrial or interventricular septal defect）, and 28 with complicated congenital heart diseases （tetralogy of Fallot, partial/complete atrioventricular canal, double outlet of right ventricle, etc.）. Membrane oxygenator （Terumo Baby-RX or Maquet VKMO 10000） was used in ECC, and the volume of priming solution （Ringer lactate solution and human serum albumin） was 250-450ml. During ECC, the perfusion flow rate was 90-150ml/ （kg.min）, mean arterial pressure was maintained at 35-50mmHg, hematocrit （Hct） at 0.20-0.30, and rectal temperature at 25- 32~C. Histidine-Tryptophan-Ketoglutarate （HTK） solution was used for myocardial preservation during the operation. VAVD was routinely used in ECC with negative pressure of-10 to -30mmHg. The combined ultrafiltration technique was also routinely used, i.e. conventional ultrafiltration was applied in ECC and modified ultrafiltration was applied after ECC. Results The ECC time was 30-174 （82.6 ± 31.2）min and aortic clamping time was 6-125 （51.7 ± 30.1）min. The peripheral circulation and arterial blood gas values were normal during ECC in 72 infants, and the cardiac spontaneous resuscitation rate was 94.4%（68/72 cases）. The volume of conventional ultrafiltration during ECC was 60-380ml and the volume of modified ultrafiltration after ECC was 50-230ml. After the end of modified ultrafiltration, Hct was 0.32 -± 0.11. The volume of intraoperative red blood cell
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2014年第1期57-60,共4页
Medical Journal of Chinese People's Liberation Army
关键词
心脏缺损
先天性
体外循环
超滤
静脉引流
负压辅助
heart defects, congenital
extracorporeal circulation
ultrafiltration
venous drainage, vaccum-assisted
infant
