新生儿心内直视手术的体外循环管理

目的总结新生儿心脏手术的体外循环(ECC)管理经验。方法回顾性总结2003年1月至2005年5月新生儿心内直视手术16例,年龄2~28天,体重1.9~3.6kg。体外循环中采用低温低流量9例,深低温停循环4例,中度低温中流量3例,全部采用4:1冷血心肌保护液,术中和停ECC后应用平衡超滤与改良超滤。结果所有病例均自动复跳,并顺利脱呼吸机。轻度水肿10例,中度水肿3例。13例痊愈出院,3例死亡。结论新生儿体外循环中,应用平衡超滤与改良超滤技术,尽量减少术中液体蓄积,加强心肌保护以及肺、脑等器官保护是确保手术成功的关键。

Administration of extracorporeal circulation for open heart operation in newborn infant

ObjectiveTo summarize the administrative experiences of extracorporeal circulation for open heart operation in newborn infants. MethodsFrom Jan 2003 to May 2005, 16 cases with open heart operation were collected and their data of extracorporeal circulation were retrospectively analyzed. The ages of the patients were 228 days, and the body weights were 1.93.6kg. In the courses of extracorporeal circulation, 9 cases were applied with hypothermy and low-flow, 4 cases were applied with profound hypothermia and circulation-stopping, and 3 cases were applied with moderate hypothermia and middle flow. All the cases were applied with 4:1 cold-blood myocardial preservation fluid. Balance ultrafiltrate and modified ultrafiltrate were applied during the operation and after stopping the extracorporeal circulation. ResultsThe heartbeats of all the cases recovered automaticly and they escaped the breathing machine successfully. There existed slight edema in 10 cases and middle edema in 3 cases. 13 patients fully recovered from the operations and 3 patients died. ConclusionDuring the extracorporeal circulation for open heart operation in newborn infant, following aspects are the key points to ensure the success of operations: applying the balance ultrafiltrate and modified ultrafiltrate; reducing fluid accumulation as far as possible; preserving the myocardial, pneumono and encephalo function.