婴幼儿体外循环预充液调整临床探究.docVIP

婴幼儿体外循环预充液调整临床探究 　【关键词】 血流动力学； 摘要：目的 通过对体外循环（CPB）预充液的改良调整，观察其对婴幼儿术中内环境及血流动力学的影响。方法 16例10kg以下的先天性心脏病患儿在常规预充的基础之上，通过血气结果对预充液进行改良调整并充分氧合，使预充液的内环境更接近机体内环境，记录预充液调整前后及CPB前中后的血气参数和CPB前中后的血流动力学指标。结果 经改良调整后的预充液pH、PCO2、PO2、SO2、Mg2+、BE、HCO3-均显著改善（Plt;0.01），渗透压增高与调整前比较有显著性差异（plt;0.01）；术中血气结果均与术前无差异（Pgt;0.05）；血流动力学指标在CPB过程中得到有效维持，所有患者在CPB期间均未使用血管活性药物维持血压。结论 10kg以下的婴幼儿CPB预充液改良调整将有利于术中内环境的维持和血流动力学的稳定。 　　关键词：婴幼儿；体外循环；调整；血流动力学； 　　A Clinic Study of Cardiopulmonary Bypass Prime Solution Adjustment in Infant Heart Surgery 　　Abstract: OBJECTIVE To evaluate the effects of prime solution adjustment on homeostasis and hemodynamic state of cardiopulmonary bypass(CPB) in infant undergoing open heart surgery.METHODS 16 congenital heart disease infants weighted below 10kg were studied. Based on the conventional CPB prime, we modified the prime solution using 5% NaHCO3 and 10% MgSO4. At the same time the prime solution were oxygenized through 60% oxygen mixed air. We observed the changes of the blood gas and electrolyte and hemodynamic situation througout the procedure. RESULTS PH, PCO2, PO2, Mg2+, BE and HCO3-(Plt;0.01) were optimized in the adjusted prime solution. Osmotic pressure of modified prime solution higher than that of conventional prime solution (plt;0.01). Blood gas and electrolyte results in CPB period were similar to that of pre-CPB period(Pgt;0.05). Hemodynamics could be maintained perfectly during the CPB period and no vasoconstrictor was given during CPB.CONCLUSION For infants under 10kg the CPB prime solution adjustment contributes to the homeostasis and hemodynamic stability in heart surgery . 　　Key words： Infant；Cardiopulmonary bypass; prime；hemodynamics 　　由于婴幼儿各器官发育的不成熟性，尤其是先心病患儿生长发育滞后，重要脏器功能不完善，机体储备能力低下，在体外循环（CPB）并行期间血流动力学不稳定一直是婴幼儿CPB研究领域的重中之重［1］。婴幼儿有效血容量低，CPB预充相对比例增高，往往达到1~1.5倍的血容量，如何降低大量库血预充液对患儿机体内环境的影响是婴幼儿体外循环关注的焦点，本文通过对10kg以下的先天性心脏病患儿体外循环预充液的改良调整，观察了预充液对婴幼儿术中内环境及血流动力学的影响。 　　1 材料与方法 　　将连续16例10kg以下行心脏手术的婴幼儿作为研究对象，其中男7例，女9例；年龄3～24（14±6.7）m；体重5.3~10(8.34±1.52)kg；手术包括：