摘要：目的 通过对体外循环(CPB)预充液的改良调整，观察其对婴幼儿术中内环境及血流动力学的影响。方法 16例10kg以下的先天性心脏病患儿在常规预充的基础之上，通过血气结果对预充液进行改良调整并充分氧合，使预充液的内环境更接近机体内环境，记录预充液调整前后及CPB前中后的血气参数和CPB前中后的血流动力学指标。结果 经改良调整后的预充液pH、PCO2、PO2、SO2、Mg2+、BE、HCO3-均显著改善(P<0.01)，渗透压增高与调整前比较有显著性差异(p<0.01)；术中血气结果均与术前无差异(P>0.05)；血流动力学指标在CPB过程中得到有效维持，所有患者在CPB期间均未使用血管活性药物维持血压。结论 10kg以下的婴幼儿CPB预充液改良调整将有利于术中内环境的维持和血流动力学的稳定。

    关键词：婴幼儿；体外循环；调整；血流动力学；

    A Clinic Study of Cardiopulmonary Bypass Prime Solution Adjustment in Infant Heart Surgery

    ZHAO Ju, YANG Jiu-guang, LONG Cun

    (Department of CPB, Cardiovascular Institute and Fuwai Hospital,CAMS and PUMC, Beijing 100037)

    Abstract: OBJECTIVE To evaluate the effects of prime solution adjustment on homeostasis and hemodynamic state of cardiopulmonary bypass(CPB) in infant undergoing open heart surgery.METHODS 16 congenital heart disease infants weighted below 10kg were studied. Based on the conventional CPB prime, we modified the prime solution using 5% NaHCO3 and 10% MgSO4. At the same time the prime solution were oxygenized through 60% oxygen mixed air. We observed the changes of the blood gas and electrolyte and hemodynamic situation througout the procedure. RESULTS PH, PCO2, PO2, Mg2+, BE and HCO3-(P<0.01) were optimized in the adjusted prime solution. Osmotic pressure of modified prime solution higher than that of conventional prime solution (p<0.01). Blood gas and electrolyte results in CPB period were similar to that of pre-CPB period(P>0.05). Hemodynamics could be maintained perfectly during the CPB period and no vasoconstrictor was given during CPB.CONCLUSION For infants under 10kg the CPB prime solution adjustment contributes to the homeostasis and hemodynamic stability in heart surgery . ......