PDF(Pubmed)
Abstract：
Early cardiac surgery in neonates and infants with congenital heart disease has been performed since the middle to late years of the twentieth century. To date, there are very few reports of successful congenital heart surgery using cardiopulmonary bypass (CPB) in premature babies less than 1000 g with serious congenital heart disease. Limited information is available in the literature describing perfusion techniques for this extremely fragile patient population. Miniaturization of the CPB circuit contributes to multiple factors that affect this population significantly. These factors include the reduction of patient-to-circuit ratios, volume of distribution of pharmacological agents, management of pressure gradients within the CPB system, and increased tactile control by the attending perfusionist. Careful management of the physiological environment of the patient is of utmost importance and can mitigate risks during CPB, including volume shifts into the interstitial space, electrolyte, and acid-base imbalance, and intracranial hemorrhage. We report perfusion techniques successfully utilized during the surgical repair of transposition of the great arteries for an 800 g, 28-week-old neonate. CPB techniques for the smallest and youngest patients may be executed safely when proper physical, chemical, and perfusion process adjustments are made and managed meticulously.
摘要：
自20世纪中后期以来，已经对患有先天性心脏病的新生儿和婴儿进行了早期心脏手术。迄今为止,在患有严重先天性心脏病的早产儿中，很少有使用体外循环（CPB）成功进行先天性心脏手术的报道。在描述这种极其脆弱的患者群体的灌注技术的文献中可获得有限的信息。CPB电路的小型化有助于显著影响该群体的多种因素。这些因素包括患者与回路比率的降低，药剂的分布量，CPB系统内压力梯度的管理，并增加了参与灌注师的触觉控制。精心管理患者的生理环境至关重要，可以减轻CPB期间的风险。包括进入间隙空间的体积变化，电解质,酸碱不平衡，颅内出血.我们报告了在800克大动脉转位手术修复过程中成功使用的灌注技术，28周大的新生儿。针对最小和最年轻患者的CPB技术可以在适当的身体条件下安全地执行，化学,和灌注过程的调整和管理一丝不苟。
