小儿先天性心脏病并肺动脉高压体外循环管理.docVIP

小儿先天性心脏病并肺动脉高压体外循环管理 　 作者：李二田，李少民，路连芳，裴斐，周斌，张军，王永亮，曹克宏，万俊哲 【关键词】 先天性心脏病 摘要：目的　总结先天性心脏病合并肺动脉高压的患儿在心内直视纠治术中体外循环（CPB）的管理。方法　回顾性总结2000~2002年100例小儿先心病合并肺动脉高压的CPB手术，其中轻度肺动脉高压50例，中度38例，重度12例。CPB采用浅低温、中度血液稀释、高流量。转流中常规使用硝普钠，部分婴幼儿使用超滤技术。结果　CPB 22~161min，阻断主动脉10~112min，血气分析、电解质监测正常。全部患儿心脏自动复苏，无死亡和并发症。结论　先心病合并肺高压CPB转流中，应特别注意心肌保护、肺保护、酸碱平衡、电解质紊乱的纠正和扩血管药物以及超滤技术的应用。 　　关键词：先天性心脏病，肺动脉高压，体外循环 　　Extracorporeal Circulation Management In Children with Congenital Heart Disease and Pulmonary Hypertension 　　Abstract: OBJECTIVE To Summary extracorporeal circulation management of congenital heart disease with pulmonary hypertension in children.METHODS 100 cases with congenital heart disease and pulmonary hypertension extracorporeal circulation operations were performed from 2000 to 2002 were retrospective summary , among them 50 cases suffered with mild HP, 38 cases with moderate HP, 12 cases with severe HP. All adopted mild hypothermia, moderate hemodilution, high flow. Sodium nitroprusside was used routinely. Ultrafiltration was used in portion of infants.RESULTS The time of extracorporeal circulationi was from 22 minutes to 161minutes, aorta crass clamping from 10 to 112 minutes. Monitoring blood gas analysis and electrolytes within normal rang, autoresuscitation occured in every heart , no death and complication . CONCLUSION Myocardial preservation, pulmonary protection, acid-base balance and electrolyte disturbance, ultrafiltration and vasodilatoin should be attempted during extracorporeal circulation. 　　Key words：congenital heart disease(CHD) , pulmonary hypertension(HP)，cardiopulmonary bypass(CPB) 　　我院自2000年~2002年共收治100例小儿先天性心脏病合并肺动脉高压的患者，全部在体外循环（CPB）心内直视下手术，取得满意的效果。现将CPB管理体会总结如下。 　　1 资料与方法 　　1.1 临床资料 　　100例患者，男性55例，女性45例。年龄8个月~12岁（6.96±3.45）岁。体重7~35（19.6 ±7.65）kg。病种：房间隔缺损15例、室间隔缺损75例、房室间隔缺损4例、室间缺损伴动脉导管未闭6例。100例患者中合并细菌性心内膜炎10例。NYHA心功能Ⅱ级60例、 Ⅲ 级38例、Ⅵ级12例。X光显示心胸比率0.42~0.75（0.57±0.18）。心脏超声检查左室射血分数（EF）0.86~0.52（0.71±0.07）,心室短轴缩短率（FS）：54%~29%（40.89±5.65）%；三尖瓣返流法测得肺动脉压力大于30mmHg 50例,大于60mm