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目的:总结危重先天性心脏病(先心病)患儿新生儿期心内直视术的体外循环(CPB)管理经验。方法:对我院2009年度90例危重先心病患儿新生儿期行心内直视术的CPB情况进行回顾性总结分析。其中深低温停循环(DHCA)1例,深低温低流量(DHLF)结合下半身DHCA2例,DHLF43例,中度低温中低流量CPB33例,浅低温中高流量CPB5例,常温不停跳CPB6例。2例术中给予平衡超滤(ZBUF)结合常规超滤(CUF)和改良超滤(MUF),其余均给予CUF联合MUF。结果:CPB转流时间37～380(118.9±66.5)min,主动脉阻断时间14～195(74.4±40.9)min。所有病例在开放主动脉后心脏均能自动复跳。86例成功脱离CPB。1例左心发育不良(HLHS)术后转为体外膜肺氧合支持160h后死亡。本组死亡共13例,病死率14.4%。结论:接近生理的CPB预充,良好的心肌保护,选用适宜的灌注方式,合理的血气管理,联合运用各种超滤方法是确保危重先心病患儿新生儿期心内直视术成功的重要环节。
OBJECTIVE: To summarize the experience of cardiopulmonary bypass (CPB) management in neonates with critical congenital heart disease (CHD). Methods: A retrospective analysis was made on the CPB of 90 cases of critical congenital heart disease in our hospital during the neonatal period in 2009. Among them, DHCA was found in 1 case, DHLF combined with lower body DHCA in 2 cases, DHLF in 43 cases, mild hypothermia middle and low flow CPB in 33 cases, mild hypothermia middle and high flow CPB in 5 cases, and non-stop CPB in 6 cases at normal temperature. Two patients were given balanced ultrafiltration (ZBUF) combined with conventional ultrafiltration (CUF) and modified ultrafiltration (MUF), the rest were given CUF combined with MUF. Results: The CPB time was 37 ~ 380 (118.9 ± 66.5) min and the aortic block time was 14 ~ 195 (74.4 ± 40.9) min. All cases in the open aorta heart can automatically rebound. 86 cases successfully out of CPB. One case of left heart dysplasia (HLHS) died after 160 hours of adventitial membrane oxygenation. A total of 13 cases of death in this group, the case fatality rate of 14.4%. CONCLUSIONS: Physiological CPB preconditioning, good cardioprotection, appropriate perfusion, rational blood gas management, and the combination of various ultrafiltration methods are important to ensure successful neonatal cardiac surgery in critically ill children with congenital heart disease Links.