7262例体外循环临床分析

Clinical analysis of 7 262 patients undergone cardiopulmonary bypass

目的总结体外循环(cardio pulmonary bypass,CPB)管理经验及教训,为选择更安全的CPB方式提供参考。方法分析我院1964年2月至2004年12月施行的CPB心内直视手术7262例。其中男性3344例,女性3918例。包括硬件设备,转流技术,灌注师经验,术中监测及心肌保护等方面。结果全组死亡248例,占3·4%。Ⅰ组:1964年2月至1983年12月施行CPB手术464例,死亡52例,死亡率11·2%。Ⅱ组:1984年1月至1996年12月施行CPB手术1709例,死亡78例,死亡率4·6%(与Ⅰ组比较:P<0·01)。Ⅲ组:1997年1月至2004年12月施行CPB手术5089例,死亡118例,死亡率2·3%(与Ⅰ、Ⅱ组比较P<0·01)。1997年3月至2004年12月,我们对3748例患者采用心脏不停跳CPB,手术顺利,未发生与CPB转流相关的并发症。结论灌注师的经验更丰富,硬件设备更完善,高质量人工心肺机和氧合器的使用,多种转流技术的应用,完善的监测系统等,可明显提高CPB转流的安全性。心脏不停跳CPB是安全且易于管理的一种术式。

Objective To sum up the experiences and indoctrinates of the management in performing cardiopulmonary bypass so as to provide more secure methods for those patients during open heart surgery. Methods From Feb 1964 to Dec 2004, 7 262 patients underwent CPB during open heart surgery, comprising 3344 men and 3 918 women. The hardware equipments, technique, perfusioner＇ s experiences, measurements and cardiac protection were analysed during operation. Results In all patients, there were 248 cases dead and the mortality was 3.4%. All patients were divided into three groups, group Ⅰ ： from Feb 1964 to Dec 1983, 464 patients underwent CPB with the mortality of 11.2% ; group Ⅱ ： from Jan 1984 to Dec 1996, 1 709 patients with the mortality of 4.6% （P〈0. 01 in comparison with that of group Ⅰ ） ; group Ⅲ： from Jan 1997 to Jan 2004, 5 089 patients with the mortality of 2.3% （P 〈0.01 compared with those of groups Ⅰ and Ⅱ ）. In addition, from Mar 1997 to Dec 2004, 3 748 patients underwent CPB during beating-heart surgery and there were no complications correlated with perfusion. Conclusion It is obvious that the richness of the perfusioners＇ experiences, sophisticated hardware equipments, the heart-lung machine and the oxygenator of high quality, application of transferring techniques and more accurate measurements will increase the security of the CPB. CPB with beating-heart for open heart surgery is a comparatively safe and easy operation.