深低温区域性脑灌注在婴幼儿主动脉缩窄Ⅰ期矫治术中应用.docVIP

深低温区域性脑灌注在婴幼儿主动脉缩窄Ⅰ期矫治术中应用 　 作者：刘晋萍，李春华，李波，冯正义，郎亚军，龙村 【摘要】 目的探讨在婴幼儿主动脉缩窄合并室间隔缺损行Ⅰ期矫治术中，应用深低温停循环+区域性脑灌注的体外循环管理方法对患儿机体重要脏器的保护作用。方法2005年5月～2006年5月，采用深低温下半身停循环+区域性脑灌注体外循环管理方法，对11例主动脉缩窄伴室间隔缺损患儿行胸骨正中切口Ⅰ期矫治术。患儿月龄3～34个月；体重3.8～13（6.58±2.15）kg。鼻咽温度降至18℃～20℃;直肠温度降至19℃～22℃。区域性脑灌注流量15～20 ml/（kg·min）。结果本组11例患儿无一例死亡。患儿未出现中枢神经系统并发症和肾功能衰竭。术中停循环行区域性脑灌注时间18～55（32.5±16.4）min。ICU中气管插管时间38～96（54.7±12.6）h。ICU中停留时间45～112(67.9±28.4)h。结论在婴幼儿主动脉缩窄合并室间隔缺损行Ⅰ期矫治术中，采用深低温停循环+区域性脑灌注的体外循环管理方法对机体重要脏器的保护作用是安全有效的。 【关键词】 深低温停循环；区域性脑灌注；主动脉缩窄；婴幼儿 　　Application of Deep Hypothermia and Regional Cerebral Perfusion During One Stage Repair of Aortic Coarctation in Infants 　　Abstract: OBJECTIVE To discuss the protective effect of deep hypothermia and regional cerebral perfusion on major organs during one stage repair of aortic coarctation with ventricular septal defect in infants. METHODSFrom May 2005 to May 2006, under deep hypothermia and regional cerebral perfusion,11 infants who suffered from aortic coarctation with ventricular septal defect underwent one stage repair by median sternotomy. The age ranged from 3 months to 34 months,and the body weight ranged from 3.8kg to 13kg (mean 6.58kg). The temperature in nasopharynx was decreased to between 18℃ and 20℃，the temperature in rectum was controlled to between 19℃ and 22℃.The regional perfusion flow was maintained with between 15 ml/（kg·min） and 20 ml/（kg·min）. RESULTSAll patients were survived, and also have no neurological complication. The duration of regional cerebral perfusion was between 18 minutes and 55 minutes (mean 32.5minutes). The intubation time in ICU was between 38 hours and 96 hours (mean 54.7 hours)， the stay time in ICU was between 45 hours and 112 hours (mean 67.9 hours). CONCLUSIONDeep hypothermic circulatory arrest and regional cerebral perfusion is a safe way on the protective effect of major organs during one stage repair of aortic coarctation combined with VSD in infants. 　　Key words：Deep hypothermic circulatory arrest; Regional cereb