中国体外循环杂志
中國體外循環雜誌
중국체외순배잡지
CHINESE JOURNAL OF EXTRACORPOREAL CIRCULATION
2015年
2期
108-110
,共3页
先天性心脏病%新生儿%体外循环
先天性心髒病%新生兒%體外循環
선천성심장병%신생인%체외순배
Congenital heart disease%Neonates%Extracorporeal circulation
目的：总结新生儿心内直视手术的体外循环（ ECC）管理经验。方法回顾性分析本院2013年4月至2014年12月28例新生儿心内直视手术的ECC情况。男性16例，女性12例；年龄7～28（13．8±9．6）d；体质量2．3～5（3．8±0．9）kg。所有患儿均在全身麻醉ECC下完成心内畸形矫治手术。其中常温不停跳2例，常温停跳16例，中低温停循环（ MHCH）结合单侧选择性脑灌注（ASCP）10例。心肌保护均采用康斯特保护液（HTK液）。患儿均采用术中常规超滤（CUF）及术后加温式改良超滤（MUF），必要时联合零平衡超滤（ZBUF）。结果 ECC时间50～200（135±54）min；主动脉阻断时间0～188（105±68） min。所有病例在开放升主动脉后心脏均自动复跳，并成功脱离ECC。术后早期死亡2例，死亡率7．1％。结论新生儿心内直视手术的ECC有其特殊性，各个环节合理、精细、优化的管理是保障手术成功的关键。
目的：總結新生兒心內直視手術的體外循環（ ECC）管理經驗。方法迴顧性分析本院2013年4月至2014年12月28例新生兒心內直視手術的ECC情況。男性16例，女性12例；年齡7～28（13．8±9．6）d；體質量2．3～5（3．8±0．9）kg。所有患兒均在全身痳醉ECC下完成心內畸形矯治手術。其中常溫不停跳2例，常溫停跳16例，中低溫停循環（ MHCH）結閤單側選擇性腦灌註（ASCP）10例。心肌保護均採用康斯特保護液（HTK液）。患兒均採用術中常規超濾（CUF）及術後加溫式改良超濾（MUF），必要時聯閤零平衡超濾（ZBUF）。結果 ECC時間50～200（135±54）min；主動脈阻斷時間0～188（105±68） min。所有病例在開放升主動脈後心髒均自動複跳，併成功脫離ECC。術後早期死亡2例，死亡率7．1％。結論新生兒心內直視手術的ECC有其特殊性，各箇環節閤理、精細、優化的管理是保障手術成功的關鍵。
목적：총결신생인심내직시수술적체외순배（ ECC）관리경험。방법회고성분석본원2013년4월지2014년12월28례신생인심내직시수술적ECC정황。남성16례，녀성12례；년령7～28（13．8±9．6）d；체질량2．3～5（3．8±0．9）kg。소유환인균재전신마취ECC하완성심내기형교치수술。기중상온불정도2례，상온정도16례，중저온정순배（ MHCH）결합단측선택성뇌관주（ASCP）10례。심기보호균채용강사특보호액（HTK액）。환인균채용술중상규초려（CUF）급술후가온식개량초려（MUF），필요시연합령평형초려（ZBUF）。결과 ECC시간50～200（135±54）min；주동맥조단시간0～188（105±68） min。소유병례재개방승주동맥후심장균자동복도，병성공탈리ECC。술후조기사망2례，사망솔7．1％。결론신생인심내직시수술적ECC유기특수성，각개배절합리、정세、우화적관리시보장수술성공적관건。
Objective To summarize the experience of extracorporeal circulation management of neonates with open heart oper?ation. Methods We reviewed the clinical protocols of extracorporeal circulation ( ECC) in 28 neonates with open heart operation in Fujian Provincial Hospital from April 2013 to December 2014. The neonates included 16 males and 12 females. The patients were aged from 7 to 28 days ,with a median of(13.8±9.6) days;and their weights ranged from 2.5 to 5 kg, with a median of (3.8±0.9) kg. All cases underwent cardiac operation with ECC and general anesthesia. The study included 2 cases underwent normal temperature ECC on?beating heart,16 cases received normal temperature with cardiac arrest,10 cases with moderate hypothermia circulatory arrest and selec?tion cerebral perfusion. Histidine-tryptophan-ketoglutarate ( HTK) solution was used for myocardial protection. Conventional ultra fil?tration ( CUF) and warm-keeping modified ultra filtration were applied for all patients as well. Zero-balance ultra filtration was also used when necessary. Results The ECC time was 50~200 min with an average of 135±54 min, aorta cross clamping time ranged from 0~188 min with a median time of 105 ± 68 min. The heartbeat recovered spontaneously in all patients after cross clamping release ( CCR) , all patients were successfully weaned from ECC. There were two hospital deaths ( 6.7%) . Conclusion The management of extracorporeal circulation in neonates has specifial significance. Reasonable fine and optimal management of each link during extracor?poreal circulation is critical to the success of the operation.
