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Objective:To observe the effect of different temperature rewarming on intraoperative brain protection in children with deep hypothermia circulatory arrest (DHCA).Methods:Totally 24 cases of children undergoing deep hypothermia circulatory arrest under general anesthesia were selected, and randomly divided into 38 ℃ and 43 ℃ groups including 12 cases respectely. Children patients in each group were given forced air rewarming at 38 ℃ and 43 ℃ respectively during the rewarming phase after cross-clamping remission. The age of patients, weight, operation time, intraoperative blood loss, intraoperative fluid infusion and postoperative length of stay were recorded. The arterial blood was taken to determine the serum neuron-specific enolase (NSE) , Platelet activating factor (PAF), and blood lactic acid immediately when the patients were entering into operating room (T 0), before Extracorporeal Circulation (T 1), before aortic cross-clamping (T 2), before DHCA (T 3), rewarming (T 4), temperature to 30 ℃ (T 5), temperature to 33 ℃ (T 6), temperature to 35 ℃ (T 7), CPB was terminated (T 8) and at the end of operation (T 9). And the body temperature were recorded at T 0, T 1, T 3 and T 8. Results:At T 0, T 1, T 3, T 8 and T 9, the temperature difference between the two groups was not statistically significant ( P>0.05). The body temperature first decreased and then increased in the group of 38℃ and 43℃ ( P<0.01). And the serum PAF and NSE significantly increased during the operation ( F values were 5 172.087, 3 535.935, P<0.01). The content of PAF, NSE and lactate in 38 ℃ group and 43 ℃ group increased with time from T 0 to T 9 ( P<0.01).The PAF content of children in the 43℃ group at T 8 and T 9 were (20.34±4.70) μg/L and (25.46±7.75) μg/L respectively, lower than that in the 38℃ group (25.20±3.80) μg/L and (34.97±8.52) μg/L, the differences were statistically significant ( F value was 7.769, P=0.011; F value was 8.193, P=0.009). At T 8 and T 9, NSE content of children in the 43℃ group were (22.13±5.13) μg/L and (28.15±7.90) μg/L respectively, lower than those in the 38℃ group (26.92±3.89) μg/L and (36.57±8.90) μg/L, the differences were statistically significant ( F value was 6.656, P=0.017; F value was 6.012, P=0.023). Blood lactic acid content of children in the 43℃ group at T 4-T 9 respectively (2.77±0.70), (2.93±0.69), (3.13±0.77), (3.39±0.64), (3.77±0.86), (3.83±0.62) mmol/L, lower than 38 ℃ group of children (3.57±0.87), (3.82±0.80), (4.35±0.89), (4.60±0.95), (4.79±0.94), (4.92±0.92) mmol/L, the differences were statistically significant ( F values were 6.125-11.551, P values were 0.022-0.003). Conclusion:Both 38 ℃ and 43 ℃ can ensure that the body temperature of the children increases steadily during the intraoperative rewarming phase in deep hypothermic circulatory arrest operation,but 43℃ can effectively reduce the serum PAF and NSE in children with brain protection, its mechanism may be associated with reduced blood lactic acid.
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Objective To summarize the surgical results of patients with quadricuspid aortic valve and aortic regurgitation.Methods From June 2013 to June 2017,4 patients with incompetent quandricuspid aortic valve underwent surgical repair at Guangzhou Women and Children's Medical Center.The age at surgery was 2 months to 5 years,and body weight was 2.7-22.7 kg.3 patients were diagnosed with persistent tmncal arteriosus and underwent complete repair.Another one was diagnosed with tetralogy of Fallot and accepted complete repair 4 years age.All patients were diagnosed with more than moderate quandricuspid aortic valve regurgitation.Repair was performed by tricuspidalization of the native quadricuspid valve,using leaflet and related sinus of Valsalva excision.Results There was no mortality.The ICU stay and hospital stay after operation were 7-12 days and 10-16 days.The follow-up duration was 3 to 51 months.All patients were alive and free from significant aortic valve regurgitation.Conclusion Aortic valve remodeling by leaflet excision and reduction annuloplasty is an effective method for incompetent quadricuspid aortic valve repair.
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Objective:To compare the clinical effects of high volume zero-balanced ultraifltration (ZBUF) with different replacement lfuid in infant patients. Methods: A total of 40 infant patients who received aortic coarctation with deep hypothermic circulatory arrest operation in our hospital from 2012-11 to 2014-02 were summarized. The patients were randomized into 2 groups, Group A, the patients had ZBUF with plasmalyte A, n=21 and Group B, the patients had ZBUF with modiifed replacement lfuid n=19. All patients received ZBUF (15-20) ml/kg during re-warming period until the temperature reached 34°C at rectum. Blood gas analysis were conducted at 4 time points as T1 (before CPB), T2 (open ascending aorta and 5 min after calcium perfusion), T3 (ifnishing ZBUF) and T4 (end of CPB). The intra-operative CPB time and the post-operative recovery with the complication were recorded in all patients. Results: For blood gas analysis, the calcium concentration was higher in Group B than that in Group A at T3 time point, P0.05. The other indexes were similar between 2 groups, P>0.05 and the post-operative recovery was similar between 2 groups, P>0.05. Conclusion: ZBUF with modiifed replacement lfuid could avoid decreased calcium concentration and acidosis, therefore, provide a relative stable homeostasis in infant patients.