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目的总结中度低温停循环(MHCA)结合选择性脑灌注(ASCP)技术在婴幼儿一期主动脉弓部重建中的临床效果。方法回顾分析本院2009年1月-2010年12月行一期主动脉弓重建的动脉弓缩窄合并心内畸形30例患儿的临床资料。患儿平均年龄10个月(16 d~8岁),体质量3~22(6.3±3.3)kg。30例患儿体温均降至鼻咽温23~26℃,直肠温度24~28℃,患儿均在术中采用MHCA,通过无名动脉进行ASCP(20~30 mL.kg-1)的体外循环(ECC)方法。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及术后改良超滤。结果患儿均无与ECC相关的神经系统并发症,无死亡病例。ECC时间为65~170(123±23)min,主动脉阻断时间为16~95(53±18)min,ASCP时间为10~50(25±8)min,自动复跳率100%。患儿术后常规镇静清醒时间为6~95(46±26)h,机械通气时间为8~96(44±23)h,ICU滞留时间为1~12(5.5±3.5)d,住院时间为10~58(32±14)d。结论 MHCA结合ASCP等综合保护策略应用于婴幼儿一期主动脉弓重建手术中,有助于脑及重要脏器的保护,是安全可行的ECC方法。
Objective To summarize the clinical effects of moderate hypothermic circulatory arrest (MHCA) combined with selective cerebral perfusion (ASCP) in the reconstruction of aortic arch in infants. Methods The clinical data of 30 patients with aortic arch narrowing combined with intracardiac deformity underwent an aortic arch reconstruction from January 2009 to December 2010 in our hospital were retrospectively analyzed. Children with an average age of 10 months (16 d ~ 8 years), body weight 3 ~ 22 (6.3 ± 3.3) kg. Thirty patients with hypothermia were treated with nasopharyngeal temperature ranging from 23 to 26 ° C and rectal temperature from 24 to 28 ° C. MHCA was performed intraoperatively in children with ASCP (20-30 mL.kg-1) during cardiopulmonary bypass (ECC) method. Myocardial protection using CONST protector solution (HTK solution). Children with intraoperative conventional ultrafiltration and postoperative modified ultrafiltration. Results There were no neurological complications associated with ECC and no deaths in children. ECC time was 65-170 (123 ± 23) min, aortic blockade time was 16-95 (53 ± 18) min, ASCP time was 10-50 (25 ± 8) min and automatic rebound rate was 100%. The routine sedation and awake time was 6 ~ 95 (46 ± 26) h, the duration of mechanical ventilation was 8 ~ 96 (44 ± 23) h, the ICU residence time was 1 ~ 12 (5.5 ± 3.5) d, the length of hospital stay was 10 ~ 58 (32 ± 14) d. Conclusion The combination of MHCA with ASCP and other integrated protection strategies in the first stage of aortic arch reconstruction for infants and young children helps to protect the brain and vital organs and is a safe and feasible ECC method.