10 kg以下婴幼儿体外循环的体会.doc

10 kg以下婴幼儿体外循环的体会
(作者:___________单位: ___________邮编: ___________)
【摘要】目的总结20例10 kg以下婴幼儿行心内直视手术的体外循环(extracorporeal circulation,ECC)管理体会。方法 20例年龄在6个月~1岁5个月,~10 下行先天性心脏病矫治术,预充液为菲克雪浓(聚明胶肽注射液),红细胞,血浆等,ECC中常规加入甲强龙30 mg/kg,适量加入碳酸氢钠,甘露醇,氯化钾,硫酸镁,氯化钙,速尿等,ECC中维持灌注流量150~200 ml/(kg·min),平均动脉压(MAP)30 mmHg以上,心肌保护采用主动脉根部灌注冷晶体高钾液10~15 ml/kg,行常规超滤和改良超滤。结果 ECC时间33~104 min,升主动脉阻断6~61 min,ECC过程平稳,术后安返ICU,无死亡患者,均顺利康复出院。结论合理的预充、确切的心肌保护、维持较高的灌注流量、管理行之有效的方法。
【关键词】体外循环婴幼儿先天性心脏病
Abstract: OBJECTIVE To summarize the clinical experience of extracorporeal circulation (ECC) for infants weighted below 10 kg. METHODS Twenty infants with congenital heart disease, whose age ranged from 6 months to 17 months, and body weight ranged from kg to 10 kg, were operated under hypothermic with ECC. Prime liquid were polygeline injection, RBC and/or FFP. All patients were given Solu-Medrol 30 mg/kg in ECC prime. High perfusion flow (150-200 ml/(kg·min) ) and high mean arteria pressure (30 mmHg) were maintained during ECC. cardioplegia solution (10-15 ml/kg) was used for myocardial protection. Conventional ultrafiltration or modified ultrafiltration was used for all patients during ECC. RESULTS ECC time was 33-104 min, aortic cross-clamp time was 6-61 min. All the infants recoverd. CONCLUSION Reasonable priming, accurate myocardial protection, high perfusion flow and ultrafiltration technique, were