乳児期体外循環施行症例の検討 : 術中水分バランス・尿量に及ぼす因子について

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Retrospective study was carried out on 70 infants weighing less than 6kg who underwent open heart surgery for congenital heart disease to clarify the interrelation between the intraoperative factors (perfusion flow, pressure and lowest rectal temperature) and the water balance and urinary output during total cardiopulmonary bypass (CPB). The urinary volume during total bypass corelated significantly with the perfusion flow, lowest rectal temperature (RT) during CPB and especially with the perfusion pressure (r= 0.735, p<0.001). The water balance (BAL) during CPB corelated especially with RT (r=-0.704, p<0.001). When patients were divided into three groups by the priming components : A Blood containing CPD and ringer solusion (18.8 ±3.2% dilution) ; B : heparinized blood (3.7± 0.7%) ; C : heparinized blood and fresh frozen plasma (18.0 ± 2.5%), the urinary output during CPB was maintained well in group (B) and (C). The water infusion during CPB was minimized in group (C). In group C, the water balance did not corelate with urinary output but corelated with RT (r=-0.704, p<0.001). Among 15 infants in group C who underwent the closure of ventricular septal defect, postoperative AaDO_2 corelated significantly with BAL (r= 0.450, p<0.01) and RT (r=-0.744, p<0.001) . These data suggest that the excessive core cooling should be limitted to reduce the body fluid shift into interstitial apace and the sufficient perfusion flow to achieve enough pressure (< 70mmHg) would be important to maintain the renal function during CPB. Our recent protocol for CPB have the followings as an objects ; high perfusion flow (2.4-3l/min/SQm) ,high perfusion pressure (more than 70 mmHg as systolic) and moderate hypothermia (more than 28℃ as RT) under the primings of heparinized blood and frozen plasma.
日本小児外科学会の論文
1992-08-20

乳児期体外循環施行症例の検討 : 術中水分バランス・尿量に及ぼす因子について

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