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华西医院新生儿深低温手术,上演起死回生!

2016-06-06 杨丹 四川在线

华西医生将婴儿冻至“死亡” 补心手术后再起死回生。

出生2周,体重2公斤,身长40厘米的一个新生女婴芸芸(化名),在她生命中的第一个六一儿童节,被冻至“死亡”,呼吸停止,心跳停止,全身血液被抽出,心脏,血管全部被打开……

凌晨5:00,当这个还来不及有自己名字的婴儿再度睁开双眼时,她小小胸腔里跳动的,已经是一颗完整而健康的心脏,死神,再也不能把她从爸爸妈妈身边抢走。华西医院心脏大血管外科教授,主刀医生赁可揉着僵硬的脖子开心宣布:“娃娃从此拥有一个健康的心脏,这是我们送给她生命中第一个六一儿童节的礼物!”


新生儿四种病 招招要命

两周前,芸芸出生在四川大学华西第二医院,刚一出生,她就出现心衰,肺动脉高压,肺不张,医生发现她有严重的先天性心脏病,被送进新生儿ICU,经过一段时间的全力抢救,总算把芸芸救了回来,但严重的先心病是她致命的死穴,不做手术,芸芸依然“死路一条”。

于是,华西第二医院向华西医院呼救,心脏大血管外科医生随即赶到华西第二医院会诊,回到医院后将会诊情况向小儿先心病专家赁可教授汇报,赁可教授分析芸芸病情后,要求尽快转院手术;5月29日,芸芸被转至华西医院心脏大血管外科,赁可教授成为她的主管医生。

出现在赁可教授眼前的芸芸,是个足月小样儿,出生2周的她,明显比正常新生儿发育差了许多:体重2公斤,身长40厘米。检查后,赁可教授再次确诊芸芸是非常严重的先天性心脏病:主动脉弓发育不良,主动脉狭窄,动脉导管未闭,室间隔缺损15毫米,“这四种病,招招要命!”赁可教授一面给芸芸做抗心衰治疗,一面加紧做手术准备。

“小孩最要命的是主动脉弓发育不良,”赁可教授给记者解释道:“主动脉弓就像一个交通枢纽,所有从心脏泵出来的血液,都在这里完成向身体各重要器脏的血液分配,比如大脑、肝、脾、肾等重要器官。主动脉弓发育不良,所有重要脏器就会出现供血障碍,小孩无法存活。而她现在发育不良的主动脉弓,就像在用一根家用自来水管道输送石油;另外,她的心脏上,还有一个15mm的大洞,这个也很要命。”

要给芸芸做主动脉弓重建成型手术,她身体的重要脏器在手术时刻无法得到血液灌注,如何让所有脏器在没有血液灌注的时候得到保护,“唯一的选择只能是在深低温停循环脑灌注下手术,把娃娃冻至死亡状态,让她呼吸停止,心跳停止,全身血液抽出,连新陈代谢也要被将至几乎为零,仅用低流量血液灌注大脑,保护大脑不受损。”赁可教授强调:“但这种手术方式是争分夺秒的限时手术,医生操作必须控制在40分钟以内,超过这个时间,小孩重要脏器就会发生不可逆损害,比如,截瘫,肾衰,植物人,甚至死亡。”

“冻死”新生儿  争分夺秒限时手术

6月1日晚上8:00,芸芸被推进手术室,赁可教授带着两名助手走上手术台,此刻的赁可教授,已然全副武装,头上戴着高科技的头戴式显微系统,上面除了显微镜,还有顶灯,这个顶灯能把光打进手术时看不到的死角,全麻后,赁可教授从芸芸的颈根部到剑突下,开出一道10厘米长的切口,打开芸芸的胸腔,此刻,体外循环开始建立,一根管子将芸芸身体里的血,全部被抽出体外,由慢到快流进身边的体外循环机,体外循环机暂时替代了芸芸自身的心肺功能……在体外循环机里,有个变温器,芸芸的血液流过这里的时候,被逐步降温,降温后的血液再由另一根管子输回体内,由血液给身体各个部位降温……

30分钟后,芸芸的温度被降到18°,呼吸、心跳停止,就连新陈代谢也几乎将为零,达到类似死亡状态,体外循环机嘎然关机停止工作,此刻开始倒计时,赁可教授必须在规定的40分钟内完成主动脉弓重建成型。头戴显微系统的赁可教授麻利找出病变的主动脉弓,将其摊开,打开,然后切除病变最严重的主动脉弓,然后采用他最拿手的“滑动成型技术”,将芸芸心脏上的另一根血管——降主动脉拉过来与切除后的主动脉弓血管吻合……仅仅26分钟,赁可就完成了主动脉弓切除、吻合、重建、成型4大步骤,完美重建主动脉弓,“这个手术是个根治手术,不仅彻底解决了主动脉弓的发育不良,还能让主动脉弓获得了与娃娃身体同步发育的能力。”完成这个重要步骤的赁可教授有抑制不住的兴奋。

体外循环机重新工作,血液又开始在芸芸体内和机器间循环,循环的血液慢慢升温。在芸芸体温慢慢复苏的时候,赁可开始为芸芸做心内畸形修补,他用芸芸自身部分心包修补了那个15毫米的室间隔缺损,给了芸芸一个完整的心脏……紧接着,又做了动脉导管未闭切除和主动脉缩窄矫正……凌晨2:00,历时7个小时的手术结束,芸芸被送到ICU监护,今日凌晨5:00左右,云云睁开双眼,此时,她小小胸腔里,跳动着一颗完整健康的心脏。下午,查房后的赁可教授告诉记者:“孩子心脏的功能正在逐步恢复中,基本已脱离生命危险。”

深低温停循环脑灌注,20年前就进入华西

赁可教授告诉记者:深低温停循环脑灌注手术,在20年前就已进入华西医院,最开始采用在小儿先心病手术上,后来逐步扩展到成人,一年平均有30——50个先天性心脏病儿童接受这样的手术,“这是一个早已成熟的高科技手术,只是鲜为人知罢了。”芸芸并非最小的患者,赁可教授曾用这个技术为一个出生仅三天的新生儿手术,“目前,那个娃娃活得非常健康。”

赁可教授说,深低温停循环脑灌注对团队技术力量要求非常高,需要在顶级小儿心脏外科中心才能实施,它需要一支高技术的团队合作,涉及到很多专业,比如外科、新生儿科、麻醉科、ICU等,经过多学科医疗团队的合作,目前此类手术的围手术期死亡率已经成功控制在5%,“这个手术,一般是在婴幼儿先天性心脏病外科从业10年以上的医生才有资格主刀,整个手术不仅对医生要求高,对护理要求也不含糊,手术成功护理失败同样前功尽弃。”据悉,深低温停循环脑灌注手术方式,适合于主动脉发育不良、左心发育不良综合症,主动脉弓中断等先天性心脏病。

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    2016-06-08 fengyqf
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    2016-06-07 QQ4621fcb5

    怎一个赞字了得

    0

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    2016-06-07 milkshark

    这个厉害

    0

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    2016-06-07 milkshark

    值得推广

    0

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    2016-06-06 QQ6eb7ef4f

    强?!赞

    0

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