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目的总结低出生体重儿(≤2.5 kg)心内直视术的体外循环(ECC)管理经验。方法对我院34例低出生体重先天性心脏病患儿行心内直视术的ECC情况进行回顾性分析。男性22例,女性12例,出生体重1 130~2 500(2 278.3±444.6)g;孕周28~42(36.5±3.29)周。手术时日龄为3~80(23.9±15.4)d,手术日体重1 130~2 700(2 193.2±349.6)g。其中早产儿15例。所有患儿均在全身麻醉ECC下完成心内畸形矫治手术。其中深低温停循环(DHCA)2例,深低温低流量(DHLF)15例,ECC中度低温中低流量11例,浅低温中高流量3例,常温不停跳3例。1例术中给予平衡超滤(ZBUF)结合常规超滤(CUF)和改良超滤(MUF),其余均给予CUF联合MUF。结果本组病例无术中死亡。ECC转流时间35~235(109±55.9)min,主动脉阻断时间14~125(59.8±28.2)min。所有病例在开放主动脉后心脏均自动复跳,并成功脱离ECC,14例延迟关胸。术后早期死亡8例,死亡率23.5%。结论防止液体潴留,良好的心肌保护、脑保护,选用适宜的灌注方式有助于降低围术期的死亡率和并发症发生率,并提高术后生存率。
Objective To summarize the experiences of cardiopulmonary bypass (ECC) management in low birth weight infants (≤2.5 kg). Methods Retrospective analysis of ECC in 34 cases of congenital heart disease with low birth weight in our hospital underwent open heart surgery. There were 22 males and 12 females with a birth weight of 1 130 to 2 500 (2 278.3 ± 444.6) g and gestational weeks of 28 to 42 (36.5 ± 3.29) weeks. The age of operation was from 3 to 80 (23.9 ± 15.4) days and the body weight was from 1 130 to 2 700 (2 193.2 ± 349.6) g on the operation day. Among them 15 cases of premature children. All children underwent cardiac deformity surgery under general anesthesia ECC. There were 2 cases of DHCA, 15 cases of DHLF, 11 cases of moderate and low temperature ECC, 3 cases of medium and low flow in mild hypothermia, and 3 cases of non-stop beating at room temperature. One case received intraoperative balanced ultrafiltration (ZBUF) combined with conventional ultrafiltration (CUF) and modified ultrafiltration (MUF), the rest were given CUF combined with MUF. Results of this group of patients without intraoperative death. The time for ECC was 35 ~ 235 (109 ± 55.9) min and the aortic block time was 14 ~ 125 (59.8 ± 28.2) min. All cases in the open aorta heart automatically rebound, and successfully out of ECC, delayed closure of the chest in 14 cases. Postoperative early death in 8 cases, the mortality rate of 23.5%. Conclusion Preventing fluid retention, good myocardial protection, cerebral protection, and selecting proper perfusion method can help to reduce the perioperative mortality and complications and improve the postoperative survival rate.