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目的总结体重在5 kg以下的先天性心脏病(以下简称先心病)婴幼儿行心内直视手术的体外循环(ECC)管理体会。方法 881例年龄在11 h至1岁1个月,平均(74.31±57.53)d,体重0.7～5 kg,平均(4.12±0.68)kg的先心病婴幼儿在ECC下行心内直视手术,预充液为复方电解质注射液(勃脉力A)、红细胞、血浆及甲泼尼龙、碳酸氢钠、甘露醇、硫酸镁、呋塞米、白蛋白、肝素等,ECC中维持灌注流量20～200 mL/(kg.min),平均动脉压25～40 mmHg,心肌保护采用主动脉根部灌注冷康斯特保护液(HTK液)25～50 mL/kg,行常规超滤和改良超滤。结果 ECC时间13～529 min,平均(89.42±57.50)min,升主动脉阻断0～218 min,平均(44.27±27.99)min,ECC过程平稳,术中死亡4例,术后死亡20例,其余患儿顺利康复出院。结论合理的预充,确切的心肌保护,ECC中维持合理的灌注流量,行常规超滤和改良超滤,是应用于低体重婴幼儿的ECC管理行之有效的方法。
Objective To summarize the management of cardiopulmonary bypass (ECC) in infants undergoing open heart surgery with congenital heart disease weighing less than 5 kg (hereinafter referred to as CHD). Methods Eighty one hundred and seventy-eight children with congenital heart disease (ECC) undergoing open heart surgery from 11 h to 1 year old with an average of (74.31 ± 57.53) d, weighing from 0.7 to 5 kg and an average of (4.12 ± 0.68) kg were enrolled in this study. Filling fluid for the compound electrolyte injection (Pulmonary A), red blood cells, plasma and methylprednisolone, sodium bicarbonate, mannitol, magnesium sulfate, furosemide, albumin, heparin, ECC to maintain perfusion flow 20 ~ 200 mL / (kg.min), average arterial pressure 25-40 mmHg, and 25-50 mL / kg cold aortic root protection solution (HTK solution) for myocardial protection. Conventional ultrafiltration and modified ultrafiltration were performed. Results The ECC time ranged from 13 to 529 minutes (mean, 89.42 ± 57.50) minutes. The ascending aorta occlusion ranged from 0 to 218 minutes (mean, 44.27 ± 27.99) min. The ECC process was stable with 4 deaths and 20 postoperative deaths. The remaining children recovered and discharged smoothly. Conclusions Reasonable preconditioning, exact myocardial protection, reasonable perfusion flow in ECC, routine and ultrafiltration, are effective methods for ECC management of infants with low birth weight.