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目的总结体质量<5 kg婴儿心内直视手术体外循环(CPB)的管理经验。方法回顾性分析行心内直视手术的体质量<5 kg婴儿168例的临床资料。男104例,女64例;年龄3 d~6个月;体质量2~5 kg其中常温5例,浅低温88例,中低温52例,深低温低流量23例,深低温停循环选择性脑灌注10例。深低温患儿应用pH稳态、甲泼尼龙、甘露醇。CPB中监测ECG、平均动脉压、经皮血氧饱和度、鼻咽温、肛温、尿量和中心静脉压。结果 CPB时间为18~155(45.26±23.36)min;主动脉阻断时间为18~85(33.22±20.25)min;自动复跳率为98.2%。患儿均顺利脱离CPB。15例出现并发症,包括低心排综合征、低氧血症各3例,延迟关胸2例,肺不张、气胸、肾功能不全、纵隔感染、消化道出血各1例,再次开胸止血及残余分流各1例。术后死亡4例,病死率为2.34%,主要死亡原因为心肺功能衰竭。结论 CPB中应用个体化管理和采用综合措施是婴儿心内直视手术成功的保障。
Objective To summarize the management experience of Cardiopulmonary Bypass (CPB) in infants who have a body mass <5 kg. Methods Retrospective analysis of clinical data of 168 cases of infants with body mass <5 kg undergoing open heart surgery. 104 males and 64 females; aged 3 d to 6 months; body weight 2 to 5 kg of which 5 cases of normal temperature, 88 cases of mild hypothermia, hypothermia in 52 cases, 23 cases of deep hypothermia and low flow, Brain perfusion in 10 cases. Children with hypothermia pH steady state, methylprednisolone, mannitol. ECG, mean arterial pressure, transcutaneous oxygen saturation, nasopharyngeal temperature, rectal temperature, urine output and central venous pressure were monitored in the CPB. Results The CPB time ranged from 18 to 155 (45.26 ± 23.36) min, the aorta occlusion time ranged from 18 to 85 (33.22 ± 20.25) min, and the spontaneous rebound rate was 98.2%. Children were successfully out of CPB. 15 cases showed complications, including low cardiac output syndrome, hypoxemia in 3 cases, delayed closure of the chest in 2 cases, atelectasis, pneumothorax, renal insufficiency, mediastinal infection, gastrointestinal bleeding in 1 case, reoperation Hemostasis and residual shunt in 1 case. Postoperative death in 4 cases, the case fatality rate was 2.34%, the main cause of death for cardiopulmonary failure. Conclusion The application of individualized management and comprehensive measures in CPB are the safeguards for the success of open heart surgery in infants.