婴幼儿长时间体外循环风险分析

Objective To explore the risk factors of long-time cardiopulmonary bypass in 308 infants with congenital heart disease. Methods Among 3879 cases of cardiopulmonary bypass, 308 cases experienced a long perfusion time (more than 120min) were reviewed. The techniques of CPB was adopted, including moderate hypothermia moderate flow perfusion, deep hypothermia low flow perfusion and deep hypothermia arrest. Ultrafiltration was applied in all cases, and liquid （250.7±148.2）ml removed. The hematocrit (HCT)was 23%～28% during perfusion and 28%～33% at the end of operation. Observations of the indexes such as the functions of organs after surgery, the degree of edema, the amount of bleeding, incidence rate of hemoglobinuria, time of respirator operation, time spent in Intensive Care Unit and mortality. Results After operation, facial edema was not found obvious in those infants with perfusion for120～240min, mild or moderate edema was observed after perfusion for more than 240min. the amount of bleeding was 55～320ml (62.3±109.6)ml, hemoglobinuria occurred in 35 (35/308, 11.4%) infants, but disappeared in 16 cases within 12h. 23 cases experienced peritoneal dialysis (7.46%) because of the occurrence oliguria. Multiple organ failure occurred in 45cases. 28 cases died, the mortality rate was 9.09% (vs1.26%, 45/3571). Conclusion The complication and mortality were significantly increased in infants after long-time extracorporeal circulation. Therefore, effective measures should be taken, including rational application, careful management and ultrafiltration, as well as integral protection of vital organ.