摘要
目的总结15岁以下儿童心脏瓣膜置换术中体外循环的特点，探讨最佳的体外循环方法。方法回顾性分析2006年1月至2016年1月上海交通大学医学院附属新华医院15岁以下61例行瓣膜置换患儿临床资料。其中男性39例、女性22例，年龄1～15岁；先天性瓣膜发育异常36例、感染性心内膜炎9例、先天性心脏病术后13例、瓣膜成形术后3例。所有手术均使用进口中空纤维膜式氧合器，浅或中低温中高流量灌注，采用4：1冷氧合血灌注进行心肌保护。全组患儿术中使用常规超滤，部分患儿术后使用改良超滤。结果患者CPB时间（115．5±57．1）min，主动脉阻断时间（65．5±39．4）min，术中灌注压30-60mmHg，转流过程平稳，尿量满意，心脏自动复跳率96％，全部顺利脱机。全组院内死亡1例（1．6％），术后出现并发症6例（9．8％）。结论儿童瓣膜手术的体外循环、合理的预充和血液稀释、良好的心肌保护、充分的组织灌注、超滤技术的应用等是降低儿童瓣膜置换手术后并发症、提高体外循环质量的重要方法。
Objective To summarize the cardiopulmonary bypass characteristics of mechanical valve re- placement in children who under 15 year-old. Methods From Jau.2006 to Mar. 2014, 51 children, aged 1 to 15 year-old underwent mechanical valve replacement in Xinhua Hospital, School of Medicine, Shanghai Jiaotong Uni- versity. There were 39 male with mean age of years old. All operations included 29 cases with aortic valve replace- ment, 22 cases with mitral valve replacement, 7 cases with double valve replacement and 3 with tricuspid valve replacement. Imported membrane oxygenator was used in every patient. We operated for a low to moderate hy- pothermia and moderate to high flow perfusion strategy. Myocardium protection was achieved by mixture of cold oxygenated blood cardioplegia （4：1 for blood and crystal solution）. Results The average CPB time was （115.5±57.1 ）minutes, and average aortic cross-clamping time was （65.5±39.4）minutes. The perfusion pressure during the operation was 30-60 mm Hg. All the extraeorporeal circulations were uneventful and achieved reasonable urine output. 96% hearts recovered spontaneously and no patient had difficulty in weaning off the cardiopulmonary by- pass. 60 cases were discharged well, while one patient died in hospital. Six cases had complications. Conclusion Several strategies were used to decrease the complications of the cardiac surgery, including appropriate prime and hemodilution, reasonable flow and perfusion pressure, careful fluid balance management, superior myocardium protection, and ultrafiltration application.
出处
《中国心血管病研究》
CAS
2017年第11期991-994,共4页
Chinese Journal of Cardiovascular Research
关键词
体外循环
瓣膜置换术
儿童
Valve replacement
Cardiopulmonary bypass
Children
