心脏跳动中二尖瓣置换术（附137例报告）

Mitralvalvereplacementunderbeatingheartin137cases

为了避免心肌缺血缺氧和再灌注损害，在维持心脏的血液供应及其生理活动最低限度的内环境要求下，我们在浅低温（３１～３５℃）体外循环心脏跳动中二尖瓣置换术，１３７例风心，先心二狭二闭，或合并主动脉瓣关闭不全的患者，接受了这个手术方法的治疗。不阻断主动脉，不灌注心脏停跳液，心脏空跳慢跳每分钟４０～５０次，术中鼻温控制在３２±１℃之间。合并主动脉瓣关闭不全者先在心脏冷停跳中置换主动脉瓣，而后在心跳中置换二尖瓣，以缩短心脏泠缺血时间，三尖瓣成形术亦在心脏跳动中施术。术后病人病情平稳，平均动脉压维持在９．５～１０．５ｋＰａ（７０～８０ｍｍＨｇ）之间，多巴胺用量明显减少其使用时间明显缩短。术后无低心排综合征、急性肾功能衰竭和严重心律紊乱者，术后死于感染和凝血机能障碍４例。本组手术死亡率２．９％（４／１３７）。为了排出左心腔内的积气，自行设计的左心腔无层级排气装置和主动脉灌流导流装置，术后无气栓症状和体征者。

Toavoiddamageofmyocardialischemia,myocardialhypoxiaandreperfusioninjury,wedesignedmitralvalvereplacementinbeatingheartunderextracorporealcirculationwithlowdosetem-peratureof31℃to35℃in137casesofrheumaticheartdisease,congenitalheartdiseasemitralstenosisandmitralinsuficiency,orconcurentaorticinsuficiency.Thepatientswerereptinunblockingaorta,unfilingcardiacarestperfusion,idlepulseanddradycardiaof40～50times/min,nosetemperatureof32±1℃.Patientswithconcurentaorticinsuficiencyshouldfirstundergoreplacementofaortundercoldcardiacarestandthenreplacementmitralvalveunderbeatinghearttoreducethetimeofcoldheartis-chemia.Plasticsurgeryfortricuspidvalvewasdoneunderbeatingheart.Goodpostoperativeprognosiswasnated:anaveragearterialpressureof9.5～10.5kPa(70to80mmHg),doseofdopaminewasobvi-ouslyreduced.Nolowcardiacoutputsysdrome,acuterenalfailureandseverearrythmiawereobservedin137cases,except4deathsduetoinfectionandbloodcoagulation(2.9%).Aleftcardiacchamberno-levelairremovaldeviceandaortaperfusionerleadingflowdeviceweredesignedforexsuflationofleftpneumatocardia.