新生儿心内直视手术的体外循环管理
体外循环管理,,新生儿；体外循环,1资料与方法,2结果,3讨论,参考文献：
摘要：目的 总结新生儿心内直视手术体外循环管理经验。方法回顾性总结1999年9月~2004年5月新生儿心内直视手术45例，其中急诊手术11例。体外循环(CPB)中采用深低温停循环22例，中度低温15例，浅低温8例。心肌保护应用4℃冷晶体停搏液一次灌注(34/45)或10℃氧合冷血20min间断灌注(11/45)。增加预充液胶体成份，调节预充液pH及维持正常离子浓度。转流中平衡超滤(BUF)+改良超滤(MUF)结合，使用药物进行血液保护。深低温停循环者降温期用 pH 稳态(pH-STAT)管理。重视保温。结果术后1例死于低氧血症，5例死于低心排并发肾功能衰竭。结论 体外循环中采用综合性措施是取得新生儿手术成功的保障。关键词：新生儿；体外循环
Management of Cardiopulmonary Bypass 〖JZ〗in Open Heart Surgery on Neonates
WU Li-li ,WANG Zhen-xiang ,QIAO Bin, WANG Tong-jian, ZHANG Feng-quan,, JIANG Yi-yan, NING Yan -song, DUAN Hai-yun
( Department of cardiac surgery 106 Hospital of PLA,Shandong JInan ,250022 China)
Abstract: OBJECTIVE To summary Cardiopulmonary bypass management in open heart surgery of neonates.METHODS 45 cases neonatal open heart procedures with CPB were performed from SEP. 1999 to MAY. 2004. Among them, 11 cases were emergent operations. 22 cases were done with deep hypothermic circulatory arrest, 15 cases were subjected to mild hypothermia, moderate hypothermia was used in 8 cases. In 34 of the 45 cases single shot cold crystalloid cardioplegia at 4℃. In the remaining 11 cases oxygenated cold blood cardioplegia perfusion at 10℃ perfusion for 20 minutes was used. We increased the colloid component of the priming solution, adjusted the pH of the priming solution and kept the ionic concentration constant. We used the combination of BUF+MUF. PH-STAT was adopted to reduce the temperature in DHCA. Special care was taken to keep the temperature constant.1case died of hypoxemia, 5 cases died of low cardiac output and renal failure after operation.CONCLUSION Comprehensive measures were taken to ensure the successful application of CPB in neonatal operations. ......
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