老年人长时间心内直视手术的体外循环管理

Management of cardiopulmonary bypass in long -time open heart operations in elder patients

目的总结老年人长时间心内直视手术体外循环的管理经验。方法2003年9月至2005年9月老年人长时间体外循环(CPB)心内直视手术36例,其中采用深低温停循环2例、中度低温34例。使用主动脉球囊反搏(IABP)辅助7例,离心泵左心辅助循环4例,应用改良超滤(MUF)8例,心肌保护应用氧合血心肌停搏液。根据病情选用顺灌、逆灌、桥灌及顺灌逆灌间断灌注的灌注方法。实施血液保护、脑保护、心肌保护、肺保护、肾保护。结果1例冠状动脉移植合并室壁瘤切除术患者,术后因多脏器功能衰竭死亡,其余均顺利康复出院。结论体外循环中采用综合性措施是老年人长时间心内直视手术成功的保证。

Objective To summarize the management of cardiopulmonary bypass （CPB） in long time open heart operations in elder patients. Methods 36 cases undergoing long time CPB from September 2003 to September 2005 were analyzed retrospectively, deep hypothermia circulatory arrest was emploied in 2 cases, moderate hypothermia in 34 cases; 7 cases were assisted by IABP, 4 cases by left ventricular assist devices; modified uhrafihration was used in 8 cases, and oxygenized cardioplegic solution was used for myocardial protection for all; irrigation methods were chosen according to the conditions of patients, and blood protections for cerebrum , myocardium, lungs and kidneys were reinforced in operation. Results 1 case with ventricular aneurysm resection died for multiple system organ failure after CABG, others were discharged without complications. Conclusion Multiple methods of CPB could guarantee the success of long time open heart operation. Comprehensive measures should be taken to ensure the successful application of CPB in operations.