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目的探讨和总结患有先天性心脏病的重症婴儿进行外科治疗采用体外循环的临床策略。方法回顾总结64例心内直视手术的重症婴儿的临床资料,根据患儿病情的不同,在术中采用浅度低温(24例,37.5%)、中度低温(27例,42.2%)和深低温低流量流转(13例,20.3%)的体外循环方法;心肌保护措施采用不阻断主动脉心不停跳(10例)或阻断主动脉根部间断灌注的方法;术中联合使用改良超滤和普通超滤;术后进行呼吸机支持、改善心脏泵血功能、保护重要脏器和营养支持等监护治疗。结果全部患儿CPB循环时间为41～163 min,平均(105.2±17.3)min,主动脉阻断时间0～84 min,平均(48.32±18.54)min;60例均自动复跳,自动复跳率为93.8%;术后呼吸机支持时间6～149 h,平均(16.9±7.5)h;8例发生并发症,2例死亡,病死率3.1%,其余均痊愈出院。结论首先,从设备选材上来说,应该选择优质的体外循环管道和氧合器;其次,从婴儿患者来说,要根据患儿的具体情况采取合理的预充预案,手术过程中选择合理的体外循环方案,术前要对患儿进行合适的超滤和保护重要脏器的操作;最后,在术后还要对患儿进行监护治疗,保证手术能达到更好的临床效果。
Objective To investigate and summarize the clinical strategy of using cardiopulmonary bypass during the surgical treatment of severe infants with congenital heart disease. Methods The clinical data of 64 infants with severe open heart surgery were retrospectively reviewed. According to the different conditions of children, mild hypothermia (24 cases, 37.5%), mild hypothermia (27 cases, 42.2%) and (13 cases, 20.3%) of cardiopulmonary bypass method; myocardial protection measures do not block the aortic heart beating (10 cases) or blocking the aortic root intermittent perfusion method; combined use of surgery to improve Ultrafiltration and ordinary ultrafiltration; postoperative ventilator support, improve cardiac pump function, protection of vital organs and nutritional support custody treatment. Results All patients had CPB cycle time of 41 to 163 minutes (mean, 105.2 ± 17.3) min and aortic block time of 0 to 84 min (average, 48.32 ± 18.54) min. (93.8%). Postoperative ventilator support time was 6 to 149 hours with an average of (16.9 ± 7.5) hours. Complications occurred in 8 patients and 2 patients died. The mortality rate was 3.1%. The rest were cured and discharged. Conclusion First of all, from the equipment selection, it should choose high-quality extracorporeal circuit and oxygenator; Second, from infants, according to the specific circumstances of children to take a reasonable preconditioning program, the surgery process to choose a reasonable in vitro Circulation program, the preoperative children with appropriate ultrafiltration and protection of vital organs of the operation; Finally, after surgery but also for children with custody treatment to ensure that surgery can achieve better clinical results.