Xi Da-wei, Yu Cheng-zhong, Qiu Hai-yan
Department of Pediatric and Cardiovascular Surgery, Ningbo Women and Children's Hospital, Ningbo, Zhejiang 315012, China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2015 Apr;37(2):230-3. doi: 10.3881/j.issn.1000-503X.2015.02.016.
To explore the role of cardiopulmonary bypass (CPB) with vacuum assisted venous drainage(VAVD)in the management of newborns with congenital heart diseases.
Total 15 newborns with congenital heart diseases (11 males and 4 females)underwent heart operations. Their age ranged from 2 days to 28 days [mean:(15.67 ± 2.22)days], and their body weight from 2.3 kg to 4.8 kg [mean: (3.75 ± 0.19)kg]. Sternal median incision was made to establish CPB,during which VAVD was applied for all the newborns.
In these 15 newborns,the mean CPB time was from 50 minutes to 343 minutes [mean:(170.3 ± 26.6)minutes], and the mean aortic clamping time ranged from 20 minutes to 172 minutes [mean:(85.8 ± 14.6)minutes]. No macroscopic hematuria, inadequate drainage, or cannulation vena cava difficulty was observed during the procedures. All the newborns were successfully weaned from the machine. No neurological complication due to micro air embolus caused by negative pressure was noted. No vena cava infarction, thrombosis, or other complication was reported after the surgery, although one patient died after the surgery and another patient was discharged upon its family's own decision.
VAVD is a safe, simple, and cost-effective technique. Appropriate negative pressure can the resistance during thinner venous intubation and thus speed up blood drainage,provide adequate perfusion flow,and reduce the pre-filling volume.
探讨采用真空辅助静脉引流（VAVD）的体外循环（CPB）在新生儿先天性心脏病治疗中的作用。
15例先天性心脏病新生儿（男11例，女4例）接受心脏手术。年龄2天至28天[平均：（15.67±2.22）天]，体重2.3 kg至4.8 kg[平均：（3.75±0.19）kg]。采用胸骨正中切口建立CPB，所有新生儿均应用VAVD。
这15例新生儿中，CPB时间平均为50分钟至343分钟[平均：（170.3±26.6）分钟]，主动脉阻断时间平均为20分钟至172分钟[平均：（85.8±14.6）分钟]。术中未观察到肉眼血尿、引流不畅或腔静脉插管困难。所有新生儿均成功脱离体外循环机。未发现因负压导致的微小空气栓塞引起的神经并发症。术后未报告腔静脉梗死、血栓形成或其他并发症，尽管1例患者术后死亡，另1例患者经家属自行决定出院。
VAVD是一种安全、简单且经济有效的技术。适当的负压可降低较细静脉插管时的阻力，从而加快血液引流，提供充足的灌注流量，并减少预充量。
