CAJ | 학술논문

目的总结10 kg以下婴幼儿先天性心脏病手术体外循环(cardiopulmonary bypass,CPB)中和术后的管理资料,探讨低体重患儿CPB管理经验.方法回顾性分析我院2010年1月至2011年4月收治的122例年龄1.5个月～2岁、体重3～10kg的婴幼儿在浅低温或中低温CPB下行先天性心脏病手术治疗的临床资料.结果 122例患儿,转流时间13 ～118 min,平均(62.69 ±21.48) min;主动脉阻断时间0 ～ 86 min,平均(35.47±19.51) min;心脏全部自动复跳,转流过程平稳,停机顺利,未发现与CPB相关的严重并发症.3例患儿术后死亡(2.46％,3/122).结论对10 kg以下的低体重先天性心脏病患儿行CPB时,应使用预充量尽可能少的膜式氧合器、管道及微栓过滤器,转流过程保持较高灌注流量,保证血流动力学稳定,维持合理的红细胞压积和胶体渗透压,提供良好的心肌保护,并且应用超滤技术减轻术后水肿的发生.
목적 총결10 kg이하영유인선천성심장병수술체외순배(cardiopulmonary bypass,CPB)중화술후적관리자료,탐토저체중환인CPB관리경험.방법 회고성분석아원2010년1월지2011년4월수치적122례년령1.5개월～2세、체중3～10kg적영유인재천저온혹중저온CPB하행선천성심장병수술치료적림상자료.결과 122례환인,전류시간13 ～118 min,평균(62.69 ±21.48) min;주동맥조단시간0 ～ 86 min,평균(35.47±19.51) min;심장전부자동복도,전류과정평은,정궤순리,미발현여CPB상관적엄중병발증.3례환인술후사망(2.46％,3/122).결론 대10 kg이하적저체중선천성심장병환인행CPB시,응사용예충량진가능소적막식양합기、관도급미전과려기,전류과정보지교고관주류량,보증혈류동역학은정,유지합리적홍세포압적화효체삼투압,제공량호적심기보호,병차응용초려기술감경술후수종적발생.
Objective To summarize the management of cardiopulmonary bypass(CPB) for infants below 10 kilograms with congenital heart diseases.Methods From Jan 2010 to Apr 2011,the clinical datas of 122 infants aged from 1.5 months to 2 years with body weight 3 to 10 kilograms,who underwent open heart surgery under mild or moderate hypothermia CPB were retrospectively analyzed.Results Among all the 122 infants,CPB time was 13 ～ 118 min [(62.69 ± 21.48) min],aortic cross-clamp time was 0 to 86 min [(35.47 ± 19.51) min].All patients were spontaneous resuscitation and successfully weared from the machine,no severe complications associated with CPB occurred,3 infants died (2.46％,3/122) after operation.Conclusion Using membrane oxygenator,circuit tubing and artery filter with less priming,and highflow perfusion during CPB,maintaining hemodynamics stable,holding reasonable hematocrit and colloid osmotic pressure,good myocardial protection and ultrafiltration are the significant elements of the management of CPB in infants with weight less than 10 kilograms.