8公斤以下婴幼儿先心病体外循环管理.DOCVIP

临床医学论文-8公斤以下婴幼儿先心病体外循环管理 ???????????????? 作者：李艳青，查光彦，张庆祥，张爽，任淑霞???? 【关键词】? 婴幼儿 ??? 摘要：目的 回顾我院37例婴幼儿先心病的体外循环（CPB）管理，总结8kg以下婴幼儿先心病外科手术中的灌注技术。方法 对我院2002年12月~2003年10月的37例8kg以下婴幼儿先心病手术的临床资料（年龄、性别、体重、手术类型）及CPB情况（CPB设备、预充液组成、CPB时间、升主动脉阻断时间等）做一回顾性分析。结果 全组病例男性19例，女性18例。年龄15d~20m，体重2.8~8kg，CPB时间13~175min，升主动脉阻断时间0~63 min。全组病例均顺利脱机。2例术后死亡。结论 婴幼儿CPB必须最大限度减少预充量，提供良好心肌保护和适当流量灌注，维持合理血球压积和胶晶比，使CPB整个过程趋于生理状况，同时采用超滤技术，减轻CPB后水肿，可有效提高手术的成功率。 　　关键词：体外循环；婴幼儿；超滤 　　Cardiopulmonary Bypass in Less than 8kg Infants with Congenital Heart Diseases 　　Abstract: OBJECTIVE? We reviewed the Cardiopulmonary Bypass(CPB) management of 37 infants with congenital heart diseases (CHD) to make a conclusion on the perfusion techniques in patients less than 8kg.METHODS The clinical datae ,including age,sex,body weight and operation type and CPB conditions,such as equipment,compositon of primed liquids,duration of CPB and blockage time of ascending aorta were? retrospectively analyzed in 37 infants less than 8kg in body weight undergoing CHD operations from Dec,2002 to Oct 2003 in our hospital.RESULTS? All the patients,including 19 boys and 18 girls,aged 15 days to 20 months and weighed 2.8 to 8kg ,The CPB duration ranged from 13 to 175 min,and the ascending aorta blockage time was 0～63 min,All the infants were successfully weared from the machine,and 2 died after opration.CONCLUSION The primed volume in infant CPB should be minimized to the greatest extent,thus to provide good myocardial protection and adequate infusion,maintain.reasonable Hct and colloid and crystalloid ration,and adapt the whole process nearer to physiological status.Meanwhile ultrafiltration should be used to minimize edema after CPB to enhance the success rate of operation. 　　Key words：Cardiopulmonary bypass; Infants; Ultrafiltration 　　我院于1991年就已开展了婴幼儿心内直视手术。几年来，手术技术不断改进、手术效果不断增强，尤其是2002年12月以来低月龄低体重婴儿心内直视手术所占比例越来越高，并成功地完成了一例新生儿手术。婴幼儿心内直视手术的不断发展，除了心外科技术迅速提高以外，其中更重要的原因之一就是对婴幼儿CPB的设备和灌注技术不断更新和改进。现将我院2002年12月~2003年10月期间内的37例8kg以下婴幼儿先心病临床资料和