心脑联合灌注与单纯区域性脑灌注对复杂主动脉畸形患儿术后早期预后的回顾性对比分析

发布时间：2018-07-28 16:48

【摘要】：研究目的:回顾分析心脑联合灌注和单纯区域性脑灌注两种体外循环灌注策略在复杂主动脉畸形患儿手术中的应用效果,并比较两者对患儿早期预后的影响。研究方法:收集本中心2011年1月至2014年8月141例患有主动脉缩窄或主动脉弓中断合并心内畸形的小儿术前、术中及术后相关临床资料,年龄为1个月至94个月,根据患儿术中体外循环灌注方式将其分为心脑联合灌注组(n=56)和单纯区域性脑灌注组(n=85)。回顾性观察并分析两组患儿术中各项相关参数、术后生化指标、恢复情况及不良事件发生率等,用统计学的方法比较两组患儿术后的早期预后是否存在差异。研究结果:心脑联合灌注组的术中参数如体外循环时间、停循环时间、心脏停跳时间、手术时间、复温时间等均较单纯区域性脑灌注组明显缩短(P0.001),并且心脑联合灌注组患儿术后的天门冬氨酸转氨酶、直接胆红素、总胆红素和血尿素氮、肌酐等肝肾功能指标也较明显降低(P0.001)。除此之外,心脑联合灌注组的术后恢复参数如呼吸机时间和住院时间也较单纯区域性脑灌注组有所缩短,P值分别是 0.015 和 0.007。研究结论:在小儿主动脉弓体外循环手术中,选用心脑联合灌注的改良灌注策略较单纯区域性脑灌注可使患儿获得更好的预后,使患儿的住院时间和呼吸机支持时间缩短。
[Abstract]:Objective: to retrospectively analyze the effects of cardiopulmonary bypass (CPB) perfusion strategies of combined cardio-cerebral perfusion and regional cerebral perfusion in children with complex aortic malformation and compare their effects on the early prognosis of children with complex aortic malformation. Methods: from January 2011 to August 2014, 141 children with coarctation of aorta or interruption of aortic arch with intracardiac malformation were collected. According to the cardiopulmonary bypass (CPB) during the operation, the children were divided into two groups: the combined cardio-cerebral perfusion group (NN56) and the regional cerebral perfusion group (nong85). The related parameters, biochemical indexes, recovery and incidence of adverse events in the two groups were retrospectively observed and analyzed. The early prognosis of the two groups was compared by statistical method. Results: intraoperative parameters such as cardiopulmonary bypass time, cardiac arrest time, operation time, The rewarming time was significantly shorter than that in the regional cerebral perfusion group (P0.001), and the indexes of aspartate aminotransferase, direct bilirubin, total bilirubin, blood urea nitrogen and creatinine were also significantly decreased in the combined cardio-cerebral perfusion group (P0.001). In addition, the postoperative recovery parameters such as ventilator time and hospital stay in the combined cardio-cerebral perfusion group were significantly shorter than those in the regional perfusion group (P = 0.015 and 0.007, respectively). Conclusion: in pediatric aortic arch cardiopulmonary bypass, the improved perfusion strategy of combined cardio-cerebral perfusion is better than that of regional cerebral perfusion alone, and the hospitalization time and ventilator support time can be shortened.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R726.1

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