心脏不停跳心内直视手术的临床应用

Clinic research of open-heart surgical operation on beating heart

目的探讨心脏不停跳心内直视手术临床应用的优点和局限性。方法回顾性分析203例心脏不停跳心内直视手术技术、手术效果及并发症。结果体外循环时间13～210min．平均（58．3±27．7）min．113例（55，7％）术后不需使用任何正性肌力药物，其余90例（44．3％）仅需小剂量多巴胺（2～6μg·kg^-1·min^-1）支持循环；术后呼吸机辅助呼吸时间1．5～19h，平均（7．9±5．3）h；术后血红蛋白尿24例（11．8％），多于术后3～12h恢复正常；术后发生急性肾功能不全2例（0.98％）；全组无死亡，无空气栓塞，无Ⅲ度房室传导阻滞，无严重心律失常，无神经系统症状发生。结论心脏不停跳心内直视手术是一种易于施行和安全可靠的方法，在某些方面具有一定的优越性．可作为常规手术在临床应用。

Objective To summarize the experience of 203 cases open-heart operation on beating heart. Methods 203 cases of open-heart operation were performed. Study the mean time of this operation and mean time of CPB and complications were studied. Results CPB time was 13 - 210min [ mean （58.3 ± 27.7 ） mini. 113 （55.7 % ） post-operation patients needed not circulation support by medicine and 90 （44.3 % ） post-operation patients needed only lesser dopamine （2- 6μg·kg^-1·min^-1） support; After operations the time of respiratory support by respirometer was 1.5 - 19 hours [ mean （ 7.9 ± 5.3 ） hours ] ; 24 （ 11.8 % ） patients suffered hemoglobinuria; 2 （0.98%） patients suffered acute-renal-failure（ARF） but none of the patients died of the post-operation complications. Conclusion It is safe to perform open-heart operation on beating-heart and has better myocardinal protecting affection.