体外循环技术用于非心脏外科手术探讨

Experience with Cardiopulmonary Bypass in Non-Cardiac Surgery

目的 总结体外循环 (CPB)在非心脏外科手术中应用的技术特点及体会 ,探讨安全有效的方法。方法 回顾 39例患者 ,其中布加氏综合征行根治术 2 9例 ;颅内巨大基底动脉瘤行夹闭术 4例 ;右肾癌伴下腔静脉瘤栓行右肾及瘤栓清除术 2例 ;气管癌气管梗阻行激光造孔气管内记忆合金成形术 2例 ;气管淀粉样变气管镜下行梗阻疏通术 1例 ;肝脏巨大平滑肌脂肪瘤切除余肝原位移植术 1例。CPB技术分别采用深低温停循环 (DHCA) 2 6例 ,其中包括股动 -静脉转流 (FA -V)未开胸 4例 ;深低温低流量灌注 (DHLF) 9例 ;常温静脉 -静脉 (NHV -V)转流 1例 ;NHV -V体外膜肺氧和 (ECMO)呼吸支持 2例 ;常温股动 -静脉 (NHFA -V)无泵ECMO 1例。结果 CPB转流时间 2 72 31 (1 4 6 .0 0± 4 1 .6 2 )min ;心脏阻断时间 2 81 1 3(5 6 .95± 2 3.0 2 )min ;DHCA时间 1 4 6 3(2 9.4 2± 1 1 .36 )min。低温组最低鼻咽温 1 2 .4 2 0 .7(1 6 .78± 1 .96 )℃ ,最低肛温 1 7.82 5 .0 (2 1 .5 7± 1 .96 )℃。 35例低温停跳者自动复苏 1 9例(5 4 .2 8%)。手术均获得成功 ,术后早期死亡 2例 ,1例肾癌术后急性肾功能衰竭 ,另 1例布加氏综合征术后 2周因应激性溃疡消化道大出血。结论 尽管CPB存在着一定的创伤性、技术性和费用问题 ,但对某些常?

OBJECTIVE Retrospective study of cardiopulmonary bypass (CPB) technique applied in non-cardiac surgery. METHODS 39 patients including 29 cases of Budd-Chiari Syndrome, 4 cases of intracranial basialis aneurysm, 2 cases of tracheal carcinoma and 1 case of tracheal amyloidosis, 2 cases of large inferior vena cava thrombi from renal carcinoma, and 1 case of leiomys lipoma were operated using CPB technology. Different ways of CPB were adopted as follow: 26 patients received deep hypothermia and circulatory arrest (DHCA) including 4 cases with femoral A-V perfusion without open chest, 9 patients were supported using hypothermia and low flow (DHLF) perfusion, 1 patient using veno-venous bypass in normothermia,2 patients using veno-venous extracorporeal membrane oxygenation (ECMO) and 1 patient femoral A-V bypass without pump ECMO respectively. RESULTS The CPB time was 27~231(146.00±41.62)min.The aortic clamping time was 28~113(56.95±23.02)min. DHCA time 14~63(29.42±11.36)min. The lowest nasopharyngeal temperature was 12.4~20.7(16.78±1.96)℃. The lowest rectal temprature was 17.8~25.0(21.57±1.96)℃. 19 of(54.28 %)35 cases resuscitated automatically. 2 cases died of renal failure and alimentary canal massive haemorrahage early post-operatively.CONCLUSION CPB can be used for complicated non-cardiac surgery or when surgery maybe impossible with a routine surgical method. Its disadvantages are increased trauma and higher cost.