【摘要】 目的总结新生儿心内直视手术的体外循环(ECC)管理经验。方法回顾性分析本院2013年4月至2014年12月28例新生儿心内直视手术的ECC情况。男性16例,女性12例;年龄7~28(13.8±9.6)d;体质量2.3~5(3.8±0.9)kg。所有患儿均在全身麻醉ECC下完成心内畸形矫治手术。其中常温不停跳2例,常温停跳16例,中低温停循环(MHCH)结合单侧选择性脑灌注(ASCP)10例。心肌保护均采用康斯特保护液(HTK液)。患儿均采用术中常规超滤(CUF)及术后加温式改良超滤(MUF),必要时联合零平衡超滤(ZBUF)。结果 ECC时间50~200(135±54)min;主动脉阻断时间0~188(105±68)min。所有病例在开放升主动脉后心脏均自动复跳,并成功脱离ECC。术后早期死亡2例,死亡率7.1%。结论新生儿心内直视手术的ECC有其特殊性,各个环节合理、精细、优化的管理是保障手术成功的关键。更多还原

【Abstract】 Objective To summarize the experience of extracorporeal circulation management of neonates with open heart oper-ation.Methods We reviewed the clinical protocols of extracorporeal circulation(ECC) in 28 neonates with open heart operation inFujian Provincial Hospital from April 2013 to December 2014. The neonates included 16 males and 12 females. The patients were agedfrom 7 to 28 days,with a median of(13.8±9.6) days; and their weights ranged from 2.5 to 5 kg, with a median of(3.8±0.9) kg. Allcases underwent cardiac operation with ECC and general anesthesia. The study included 2 cases underwent normal temperature ECC on-beating heart,16 cases received normal temperature with cardiac arrest,10 cases with moderate hypothermia circulatory arrest and selec-tion cerebral perfusion. Histidine-tryptophan-ketoglutarate(HTK) solution was used for myocardial protection. Conventional ultra fil-tration(CUF) and warm-keeping modified ultra filtration were applied for all patients as well. Zero-balance ultra filtration was alsoused when necessary.Results The ECC time was 50~200 min with an average of 135±54 min, aorta cross clamping time ranged from0~188 min with a median time of 105± 68 min. The heartbeat recovered spontaneously in all patients after cross clamping release(CCR), all patients were successfully weaned from ECC. There were two hospital deaths( 6.7%).Conclusion The management ofextracorporeal circulation in neonates has specifial significance. Reasonable fine and optimal management of each link during extracor-poreal circulation is critical to the success of the operation.更多还原