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目的分析婴幼儿患者长时间体外循环(CPB)对预后的影响。方法回顾性分析福建医科大学协和临床学院2008年1月至2011年11月CPB时间>120 min 308例患者的临床资料,其中男187例,女121例;年龄(1.5±1.2)岁。CPB中采用浅-中低温技术、深低温停循环、深低温低流量灌注技术。分析术后死亡率等临床结果。结果患者呼吸机使用时间12 h～30 d(32.9±41.4)h、对严重低氧血症患者加用3～10 cm H2O呼气末正压。住ICU时间48～1 600(72.9±50.2)h。病死率9.1%(28/308),死于多器官功能衰竭18例,败血症6例,其它原因4例。CPB时间120～240 min的患者头面部水肿不明显,CPB时间>240 min的患者轻-中度水肿。术后胸腔引流量55～320(62.3±109.6)ml。血红蛋白尿发生率11.4%(35/308)。尿少行腹膜透析发生率7.5%(23/308)。结论婴幼儿患者长时间CPB并发症及病死率高,精细CPB管理、超滤及注意保护重要器官是确切有效的方法。
Objective To analyze the impact of prolonged cardiopulmonary bypass (CPB) on prognosis in infants and young children. Methods The clinical data of 308 patients with CPB time> 120 min from June 2008 to November 2011 in Peking Union Medical College Hospital from January 2008 to November 2011 were retrospectively analyzed. There were 187 males and 121 females with a mean age of 1.5 ± 1.2 years. CPB in the use of light - low temperature technology, deep hypothermic circulatory arrest, deep hypothermia perfusion technology. Analysis of postoperative mortality and other clinical results. Results The patient was ventilated for 12 h to 30 d (32.9 ± 41.4 h), and positive end-expiratory pressure of 3 ~ 10 cm H2O was applied to patients with severe hypoxemia. ICU living time 48 ~ 1 600 (72.9 ± 50.2) h. The case fatality rate was 9.1% (28/308), died of multiple organ failure in 18 cases, sepsis in 6 cases and other causes in 4 cases. Patients with CPB time of 120 ~ 240 min had no obvious facial and facial edema, mild to moderate edema in patients with CPB> 240 min. Postoperative chest drainage 55 ~ 320 (62.3 ± 109.6) ml. The incidence of hemoglobinuria was 11.4% (35/308). Urinary peritoneal dialysis occurred in 7.5% (23/308). Conclusion Infants and young children have long-term CPB complications and high mortality. Fine CPB management, ultrafiltration and attention to the protection of vital organs are the effective and effective methods.