Yasui H, Yonenaga K, Kado H, Ando H, Mizoguchi Y, Honda S, Tokunaga K
Fukuoka Children's Hospital Medical Center, Japan.
J Cardiovasc Surg (Torino). 1989 Jul-Aug;30(4):661-8.
Pulsatile high-flow cardiopulmonary bypass (2.5 l/m2/min with a rectal temperature of 28 degrees C) combined with the Pulsatile Bypass Pump (Kontron Instrument) has been used at Fukuoka Children's Hospital in 259 cases of open-heart surgery in patients less than 1 year of age for a period of 5 years beginning July 1982. The overall results were satisfactory with a surgical mortality of 6.2% (VSD: 96 cases/2 deaths, TGA: 48/1, TAPVD: 34/3, Complete ECD: 15/1, IAA: 10/1, DORV: 10/1, HLHS: 7/4, TOF: 6/0, Truncus Art: 5/0, Others 28/3). The mean duration of cardiopulmonary bypass was 123 +/- 50 minutes during which time the patients had a positive water balance of only 28 +/- 38 ml per kg of body weight. The lowest positive water balance was noted in the patient group with 60-75 mmHg in peak systolic pressure and 30-45 mmHg pulse pressure divided by the pulsatile wave form. This value was significantly lower than other groups of patients with lower or higher peak systolic and pulse pressures. Urinary output during the first 24 hours after operation was 4.1 +/- 1.3 ml/kg/hour. Weight gain on the first postoperative day was 10 +/- 43 g per kg of body weight, and the duration of postoperative respiratory support was 4 +/- 5 days. In conclusion, pulsatile high-flow cardiopulmonary bypass is useful in infant open-heart surgery in light of operative techniques, water balance and postoperative recovery.
自1982年7月起的5年时间里，日本福冈儿童医院对259例1岁以下的儿童进行心脏直视手术时，采用了搏动性高流量体外循环（流量为2.5升/平方米/分钟，直肠温度为28摄氏度），并结合使用搏动性体外循环泵（康强仪器公司生产）。总体结果令人满意，手术死亡率为6.2%（室间隔缺损：96例/2例死亡；完全性大动脉转位：48例/1例死亡；完全性肺静脉异位引流：34例/3例死亡；完全性心内膜垫缺损：15例/1例死亡；主动脉缩窄：10例/1例死亡；右心室双出口：10例/1例死亡；左心发育不全综合征：7例/4例死亡；法洛四联症：6例/0例死亡；永存动脉干：5例/0例死亡；其他：28例/3例死亡）。体外循环的平均持续时间为123±50分钟，在此期间，患者每公斤体重的正水平衡仅为28±38毫升。收缩压峰值为60 - 75 mmHg、脉压为30 - 45 mmHg的患者组（通过搏动波形划分）的正水平衡最低。该值显著低于收缩压峰值和脉压较低或较高的其他患者组。术后第1个24小时的尿量为4.1±1.3毫升/公斤/小时。术后第1天的体重增加为每公斤体重10±43克，术后呼吸支持的持续时间为4±5天。总之，从手术技术、水平衡和术后恢复情况来看，搏动性高流量体外循环在婴儿心脏直视手术中是有用的。
