婴幼儿长时间体外循环风险分析.docVIP

  婴幼儿长时间体外循环风险分析# 杨立平，陈良万** （福建医科大学附属协和医院心外科，福州市，350001） 5 摘要：目的 回顾分析 308 例婴幼儿长时间体外循环（CPB）心内直视手术的转流方法及预 后。方法 收集 3879 例婴幼儿体外循环手术、其中转流时间大于 120 分钟的患儿共 308 例。 体外循环中采用浅-中低温体外循环技术、深低温停循环、深低温低流量灌注技术。所有的 患儿均采用传统超滤的方法，超滤出液体（250.7±148.2）ml。转流中红细胞压积（HCT） 10 为 23%～28%，停机时 HCT 为 28%～33%。了解术后各脏器的功能、浮肿程度、出血情况、 血红蛋白尿的发生率、 呼吸机使用时间、监护室停留时间及死亡率。结果 转流 120～240 分钟的患儿头面部浮肿不明显；转流大于 240 分钟的患儿轻－中度浮肿。术后胸腔引流 55～ 320 ml，平均 62.3±109.6 ml；血红蛋白尿 35 例，发生率 11.4%，其中 90%患儿在 12 小时 内尿色转清。尿少行腹膜透析 23 例，发生率 7.46%。术后多脏器衰竭 46 例；死亡 28 例、 15 死亡率 9.09%（vs1.26%, 45/3571）。结论 婴幼儿长时间的 CPB 并发症及死亡率明显增高， 精细体外循环管理、超滤及注意重要脏器的保护是确切有效的方法。 关键词：婴幼儿；体外循环；深低温；超滤 中图分类号：R726.542  20 25 30 35 40  Risk analysis for long-time cardiopulmonary bypass in infants YANG Liping, CHEN Liangwan (Department of cardiovascular surgery of the Fujian Medical University,Union Hospital,Fuzhou 350001,China) Abstract: Objective To explore the risk factors of long-time cardiopulmonary bypass in 308 infants with congenital heart disease. Methods Among 3879 cases of cardiopulmonary bypass, 308 cases experienced a long perfusion time (more than 120min) were reviewed. The techniques of CPB was adopted, including moderate hypothermia moderate flow perfusion, deep hypothermia low flow perfusion and deep hypothermia arrest. Ultrafiltration was applied in all cases, and liquid （250.7±148.2）ml removed. The hematocrit (HCT)was 23%～28% during perfusion and 28%～ 33% at the end of operation. Observations of the indexes such as the functions of organs after surgery, the degree of edema, the amount of bleeding, incidence rate of hemoglobinuria, time of respirator operation, time spent in Intensive Care Unit and mortality. Results After operation, facial edema was not found obvious in those infants with perfusion for120～240min, mild or moderate edema was observed after perfusion for more than 240min. the amount of bleeding was 55～ 320ml (62.3± 109.6)ml, hemoglobinuria occurred in 35 (35/308, 11.4%) infants, but disappeared in 16 cases within 12h.