Strategies for repair of congenital heart defects in infants without the use of blood.
Strategies for repair of congenital heart defects in infants without the use of blood.
复制标题
不使用血液修复婴儿先天性心脏缺陷的策略。
DOI：
10.1016/0003-4975(94)00841-t
复制
发表时间：
1995
期刊：
影响因子：
--
通讯作者：
Albert Starr
中科院分区：
文献类型：
--
作者：
Jacques A.M. van Son;H. Hovaguimian;I. Rao;Guo;Gregory A. Meiling;Douglas H. King;Albert Starr
11名体重小于10公斤(中位数为6.8公斤)的婴幼儿，其父母为耶和华见证人，接受了先天性心脏病修补术(n=10)或姑息(n=1)，不使用血液制品，有(n=9)或不(n=2)体外循环(CPB)。1例新生儿(体重3.2 kg)合并重度主动脉瓣狭窄，中度低温，阻断循环3.5min后行主动脉瓣切开术；另1例(体重7.0 kg)合并三尖瓣、肺动脉闭锁、大动脉转位、永久性左上腔静脉畸形的新生儿，在无体外循环的情况下，行双侧双向腔-肺分流术。使用肝素粘合管可以将肝素钠的初始剂量减少到1毫克/公斤。转流时组织灌注和氧合良好，平均最低pH为7.38±0.09，平均最低静脉血氧分压为65.0±36.2 mm Hg。术后平均红细胞压积(Hct)低于术前平均Hct(P<；0.05)，但术后2 h内Hct恢复到术前最低Hct(18.4%±1.4%)和术前平均Hct(42.7%±3.5%)之间。出院时红细胞压积为31.8%±1.1%。术后中位出血量为9mL/kg。无围手术期死亡。在重症监护室和医院的中位住院天数分别为2天和6天。我们的结论是，对于体重在5公斤或以上的婴儿，使用体外循环修复先天性心脏病是安全的。对于有症状的新生儿或体重较低的婴儿，最初的姑息手术绕过了CPB的使用，并允许在以后对缺陷进行二次纠正。
Eleven infants and children with a body weight of less than 10 kg (median weight, 6.8 kg) whose parents were Jehovah's Witnesses underwent repair (n = 10) or palliation (n = 1) of congenital heart defects without the use of blood products and with (n = 9) or without (n = 2) cardiopulmonary bypass (CPB). In 1 neonate (weight, 3.2 kg) with critical aortic stenosis, moderate hypothermia and a 3.5-minute period of inflow occlusion and circulatory arrest allowed an aortic valvotomy; in another patient (weight, 7.0 kg) with tricuspid and pulmonary atresia, transposition of the great arteries, and persistent left superior vena cava, a bilateral bidirectional cavopulmonary shunt procedure was performed without CPB. Use of heparin-bonded tubing allowed reduction of the initial dose of heparin sodium to 1 mg/kg. Tissue perfusion and oxygenation on bypass were adequate, as evidenced by a mean lowest pH of 7.38 ± 0.09 and a mean lowest venous oxygen tension of 65.0 ± 36.2 mm Hg. Although the mean postoperative hematocrit (Hct) was lower than the mean preoperative Hct (p < 0.05, analysis of variance and Scheffé's F test), the Hct within 2 hours after CPB was restored to a value (mean Hct, 27.5% ± 1.0%) between the preoperative Hct (mean value, 42.7% ± 3.5%) and the lowest Hct on CPB (mean value, 18.4% ± 1.4%). The Hct at discharge was 31.8% ± 1.1%. The median postoperative blood loss was 9 mL/kg. There was no perioperative mortality. The median stay in the intensive care unit and the hospital was 2 days and 6 days, respectively. We conclude that repair of congenital heart defects with the use of CPB can be safely conducted in select infants with a body weight of 5 kg or more. In symptomatic neonates or infants with a lower body weight, initial palliative procedures circumvent the use of CPB and allow secondary correction of the defect at a later time.