CAJ | 학술논문

目的：总结10 kg以下婴幼儿心脏直视术的体外循环（ ECC）管理经验。方法自2013年12月～2015年3月80例10 kg以下的先天性心脏病患儿在体外循环下行心脏直视手术。均使用进口婴幼儿中空纤维膜式氧合器和超滤器，晶体液和人血白蛋白液预充，浅或中低温中高流量灌注，心肌保护采用主动脉根部灌注HTK液，术中常规超滤和停机后行改良超滤。结果 ECC时间25～134（71±29．4）min，主动脉阻断时间20～106（51．8±21．1）min，心脏自动复跳76例，电除颤复跳4例，自动复苏率95％，转流过程平稳，全部顺利脱机。结论合理的预充和血液稀释，合适的灌注流量和灌注压，加强液体出入量的管理，以及术中良好的心肌保护，是提高婴幼儿围术期成功率的重要保障。
목적：총결10 kg이하영유인심장직시술적체외순배（ ECC）관리경험。방법자2013년12월～2015년3월80례10 kg이하적선천성심장병환인재체외순배하행심장직시수술。균사용진구영유인중공섬유막식양합기화초려기，정체액화인혈백단백액예충，천혹중저온중고류량관주，심기보호채용주동맥근부관주HTK액，술중상규초려화정궤후행개량초려。결과 ECC시간25～134（71±29．4）min，주동맥조단시간20～106（51．8±21．1）min，심장자동복도76례，전제전복도4례，자동복소솔95％，전류과정평은，전부순리탈궤。결론합리적예충화혈액희석，합괄적관주류량화관주압，가강액체출입량적관리，이급술중량호적심기보호，시제고영유인위술기성공솔적중요보장。
Objective To summarize the management of extracorporeal circulation ( ECC) for infants below 10 kilograms un?dergoing open heart operation . Methods There are 80 infants below 10 kg who received the open heart operations in our department from December 2013 to March 2015. Imported oxygenator and ultrafilter were used in all patients. Crystalloid solution and albumin solu?tion were used as the pre-filling solution. ECC was conducted with mild to moderate hypothermia and median to high perfusion flow. The histidine-tryptophan-ketoglutarate solution was applied for myocardial protection through aortic root. Conventional and modified ul?trafiltrations were applied in all cases. Results The cardiopulmonarybypass time was 25-134 (71±29.4) min.The aorta crossclamping time was 20-106 (51.8±21.1) min. Sixty-fourpatients spontaneous resuscitated (94.2%) and electrical defibrillation was used in 4 patients. All children successfully weaned from the bypass machine and was stable during ECC. Conclusion Management of consuma?bles, pre-filling, perfusion and organ protection should be strengthened in the ECC of infants with congenital cardiopathy who were be?low 10 kg in order to reduce the occurence of postoperative complications and the death rate.Reasonable priming perfusion and hemodi?lution,suitable perfusion flow and pressure, management liquid of input-output, and myocardial protection were effective ways in ECC management of infants with congeniml heart disease who have low body weight.