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患者,女性,13岁,体重45kg,诊断为先天性心脏病、房间隔缺损,心功能Ⅰ级,在数字减影及彩超引导下经股静脉右心导管行双伞闭合术。不慎手术失败,双伞闭合器脱落,随血流飘走。需紧急体外循环(CPB)下手术取出。应用Sarns-7400型人工心肺机,西京90型大号鼓泡式氧合器。先行浅低温CPB方法。鼻咽温降至30℃时阻断升主动脉,以4℃含K~+晶体停搏液行主动脉根部灌注,并以冰屑敷于心肌表面。停搏液K~+浓度20mmol/L,首次灌注量10～15ml/kg,灌注压13.3kPa,灌注时间2～3分钟。每30分钟或心肌出现电活动时灌注一次,剂量减半。动脉灌注流量2.0～2.2L·min~(-1)·m~(-2),使MAP维持8.0～10.7kPa。维持Hct20%～24%,K~+4.5～5.5mmol/L。CPB中切开右房见2.5cm×2.3cm房缺(中央型)。左、右房室内找不到异物。
Patients, females, 13 years old, weighing 45kg, diagnosed as congenital heart disease, atrial septal defect, cardiac function grade Ⅰ, under the guidance of digital subtraction and color Doppler ultrasound through the right ventricle double umbrella umbrella line closure. Accidental surgery failed, double umbrella closure off, with the blood drifting away. Need emergency cardiopulmonary bypass (CPB) surgery removed. Sarns-7400 artificial heart-lung machine, Xijing 90 large bubble oxygenator. First low-temperature CPB method. Nasopharyngeal temperature dropped to 30 â “ƒ when the ascending aorta blocked at 4 â” ƒ with K ~ + crystalloid cardioplegia perfusion of the aortic root and ice deposited on the myocardial surface. Cardioplegia K ~ + concentration 20mmol / L, the first perfusion 10 ~ 15ml / kg, perfusion pressure 13.3kPa, perfusion time of 2 to 3 minutes. Every 30 minutes or myocardial perfusion occurs when the electrical activity occurs, the dose halved. Arterial perfusion flow 2.0 ~ 2.2L · min ~ (-1) · m ~ (-2), MAP maintained 8.0 ~ 10.7kPa. Maintain Hct20% ~ 24%, K ~ +4.5 ~ 5.5mmol / L. CPB cut open the right room see 2.5cm × 2.3cm atrial (central). Left and right a room can not find foreign body.