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目的:总结10例小儿心脏移植的体外循环及供心保护策略。方法:回顾性分析我院2009-2015年共10例14岁以下小儿心脏移植的临床资料。手术在中低温、中度稀释体外循环完成,联合应用多种超滤方式。3例采用腔腔吻合方式,7例采用房房吻合方式。供心保护首先灌注冷改良St Thomas液20ml/kg,摘除供心后置入无菌标本袋内,经主动脉根部再次灌注4℃HTK液40~50ml/kg并将供心保存于其中。上台之前进行供心修剪,并灌注第2次4℃HTK液20ml/kg。结果:供心冷缺血时间为117~522(290±157)min,体外循环时间为71~217(123.6±46.7)min,升主动脉阻断时间为29~105(40.4±24.3)min。其中8例患者顺利停机,2例术后因早期移植物衰竭而使用ECMO。所有患者均康复并顺利出院,术后3周复查射血分数为(68±6.9)%,术后平均随访16个月尚无死亡病例。结论:重视体外循环管理与供心心肌保护,及时使用ECMO辅助是小儿心脏移植成功的关键。
Objective: To summarize the cardiopulmonary bypass and heart protection strategies in 10 children undergoing heart transplantation. Methods: A retrospective analysis of our hospital from 2009 to 2015, a total of 10 cases of 14-year-old children undergoing heart transplantation in clinical data. Surgery at low temperature, moderate dilution of cardiopulmonary bypass is completed, the joint application of a variety of ultrafiltration. Three cases adopted cavity anastomosis, and seven cases adopted room anastomosis. Conservative protection First perfusion cold modified St Thomas solution 20ml / kg, removed for the heart into the sterile specimen bag, through the aortic root reperfusion 4 ℃ HTK solution 40 ~ 50ml / kg and will be saved in the heart. Donor pruning was performed before the procedure, and the second infusion of 20 ml / kg HTK solution at 4 ° C was performed. Results: The duration of hypothermic ischemia was 117 ~ 522 days (290 ± 157) min. The extracorporeal circulation time was 71 ~ 217 (123.6 ± 46.7) min. The ascending aorta occlusion time was 29 ~ 105 (40.4 ± 24.3) min. Eight of these patients were successfully stopped, and two of them received ECMO due to early graft failure. All patients recovered well and were discharged smoothly. The ejection fraction was (68 ± 6.9)% at 3 weeks postoperatively. There was no death after an average follow-up of 16 months. Conclusion: Emphasis on cardiopulmonary bypass management and myocardial protection, timely use of ECMO support is the key to the success of pediatric heart transplantation.