连续110例心脏手术无死亡的体外循环研究

MANAGEMENT OF CARDIOPULMONARY BYPASS IN 110 PATIENTS UNDERGOING OPEN HEART SURGERY

目的总结2003年8月～2004年12月连续开展的110例心脏手术无死亡的体外循环（cardiopulmonary bypass，CPB）管理经验。方法各种心内直视手术110例，年龄8月～41（4．8±0．6）岁，体质量7～89（15．2±0．8）kg，全组病例均采用气管内麻醉静吸复合麻醉，使用进口膜肺和西京87型鼓泡氧和器，浅低温高流量58例，中低温中流量41例，深低温低流量8例，深低温停循环3例，均使用冷晶体停搏液（4℃）主动脉根部加压灌注，术中和术后常规超滤与改良超滤。结果100％治愈，无严重并发症，全组病例均顺利脱机。结论体外循环是开展心血管手术的重要手段，提高CPB质量是手术成功的关键。

Objective To summarize the experience of successful cardiopulmonary bypass （CPB） in 110 patients undergoing open heart surgery from Aug, 2003 to Dec, 2004 in our hospital. Methods All surgery were underwent in the intravenous inhalation combined anesthesia. Membrane oxygentores（Medtronic Mini, Medtronic NT and Dideco 705） and bubble oxygentores（xijing 87 model） were choiced in the operations. CPB methods including： mild hypothermia high flow（58 cases）, mild hypothermia mild flow（41 cases）, deep hypothermia low flow（8 cases）,deep hypothermia circulatory arrest（3 cases）. Cold crystalloid cardioplegia solution （4℃） was used in all the cases. Adopted traditional ultrafiltration during the course of operation and modified ultrafiltration after bypass. Results The cured rate was 100%. No severe complication related to the CPB. All the patients were successfully weaned from the machine. Conclusion CPB technology is the important management in the open heart surgery. Improving the quality of CPB in operation is the key point to success.