A Clinical Case Report Of Maintaining The Hemodynamic Stabilityafter Totalcavopulmonay Connection(TCPC)

Objective:To summarized the clinical treatments of maintaining the hemodynamic stability after total cavopulmonay connection（TCPC）.Methods:Select one 6 years old boy,who suffered from hemodynamic dysfunction after the TCPC,and whose weight was 16.5kg. Postoperation,routinely monitoring the heart rate（HR）,rhythm of the heart,blood pressure （BP）,central venous pressure （CVP）,left atrial pressure （LAP）,cardiac index （CI）,they were treated with ’V’ position,the upper part of the body elevates to 45°,and 30° elevation on the lower,proper respiratory alkalosis, and the PH maintained at 7.45-7.50,reference the CVP and the LAP torehydrate,and maintained in 15-20mmHg and 10-15mmHg respectively,usedopamine (5-10ug·kg^-1·min^-1),nitroglycerin (0.5-0.2ug·kg^-1·min^-1),milrinone0.25-0.75 ug·kg^-1·min^-1) to pump continued.and use Desacetyllana-toside 0.01-0.02ug/kg, three times a day intravenously.Postoperation,the low cardiac output syndrome（LCOS）occurred,inhale the iloprost hormone （ventavis） 500ng/kg.ten minutes every time,if necessary,given every tow hours administered once.Increase abdominal pressure appropriately in the right abdomen liver area in the ventilator aspirated interval, aspirated appropriate relaxation, IAP remained in the 5.0-10.0mmHg.Applicate small doses of epinephrine (0.05-0.2ug·kg^-1·min^-1).Assess the condition by monitoring indicators after half an hour,an hour,two hour,and four hour.Results:When the LCOS occursd,the patient’s blood pressure is 67mmHg and the CI is 2.01/min/m2,use the mearures above to treat symptomatically,and posttreatmet, monitoring the HR,BP, CVP,LAP, and calculate the CI respectively,the monitoring indicators of the four time points after symptomatic treatment are:blood pressure, 70mmHg,83mmHg,92mmHg and 98mmHg, CI 2.31/min/m2,2.31/min/m2, 2.71/min/m2 and 3.2 1/min/m2,the hemodynamics tend to stability,and the LCOS is rescured timelyConclusion:Preoperative strict control of surgical indications, choosing the best surgical approachs, postoperative timely treatment of low cardiac output syndrome, Postoperation,routinely they were treated with ’V’ position,proper respiratory alkalosis, fluid infusion,pressor agents and antiarrhythmic drugs. Necessarily,use the drugs of expanding the pulmonary vessels and increase the intra-abdominal pressure to improve the returned blood volume,these measures above are conducive to the stability of hemodynamics, early ventilator weaning and the improvement of success rate of surgery.