密闭式体外循环在非心脏手术中的应用

Non-Cardiovascular Application of Closed Circuit Extracorporeal Circulation

目的 探讨密闭式体外循环在非心脏手术中的应用。方法 回顾性总结 2 6 3例不同病种的患者以不同的转流途径进行密闭式体外循环所取得的经验。其中各种肝脏病变行肝移植术 1 5 6例 ,全身肿瘤病变行体外循环全身热灌注治疗 (EWBH) 98例 ,心脏手术后左心转流 2例 ,外科手术辅助循环 3例 ,体外膜肺氧合疗法 (ECMO) 4例。分别采用股静脉、门静脉 -腋静脉切开置管转流 ,左 (或右 )心房 -主动脉插管或左心室 (或降主动脉 ) -股动脉插管转流 ,股静脉 -颈内静脉 (或双侧股静脉 )经皮穿刺置管转流的方法。结果 全组除ECMO中 3例患者经治疗后心脏功能仍不能恢复 ,停机后死亡外 ,其余 2 6 0例患者转流过程平稳 ,未出现机器故障及体外循环意外 ,均顺利脱离体外循环 ,达到预期的目的。结论 密闭式体外循环目前更多地应用在非心脏手术 ,它改变了传统的体外循环管理模式 ,离心泵在密闭式体外循环中起了重要的作用。密闭式体外循环结构简单 ,安装快捷 ,操作方便 ,容易控制。密闭式装置预充量少 ,血液稀释少 ,肝素用量少 ,可作长时间转流。采用经皮穿刺的静脉插管可减少损伤 ,术后处理方便。密闭式体外循环可在广泛的领域中发挥更大的作用。

OBJECTIVE To investigate the non-cardiovascular application of closed circuit extracorporeal circulation. METHODS To summarize the experience of 263 cases using closed circuit extracorporeal circulation. 156 cases underwent liver transplantation,98 cases underwent extracorporeal whole body hyperthemia(EWBH), left heart assist bypass was adopted after open heart surgery in 2 cases, assisted circulation was used in general surgery in 3 cases, extracorporeal membrane oxygenation (ECMO) in 4 cases. RESULTS Except 3 cases died after ECMO , 260 patients were successfully weaned. CONCLUSION Closed circuit extracorporeal circulation is a new technology. It is differs from traditional cardiopulmonary bypass(CPB) management . Its advantages are simple operation,short set-up time,easy management with minimal priming volume and heparinization. Percutaneous puncture cannulation reduces trauma. The use of a centrifugal pump is advocated. Closed circuit extracorporeal circulation might play an important role in many procedures, other than cardiovascular surgery.