老年患者的体外循环管理

Management of cardiopulmonary bypass in 82 elderly patients

目的总结分析82例老年患者体外循环管理经验。方法2002年1月～2005年12月老年患者82例在我院实施体外循环心脏直视手术。全部采用气管插管、静脉复合麻醉,中度血液稀释,中度低温,2.0～2.6L.m2-1.min-1的流量,冷氧合血进行心肌保护,应用超滤器进行超滤或者平衡超滤。结果体外循环时间48～335min,阻断升主动脉时间25～230min,转流中平均动脉压维持在60～90mm Hg(1mm Hg=0.133kPa),尿量5～1 400ml,63.1%的患者进行超滤,超滤量为800～8 500ml,心脏自动复跳率81.5%。1例应用主动脉内球囊反搏(IABP),1例急诊冠脉搭桥(CABG)老年患者因低心排围术期死亡,其余康复出院。结论选择优质膜肺,控制血液稀释度,采用较高的流量,加强心肌保护,及时应用滤水器,仔细做好术中监测,注意对并发症的处理和重要器官的保护。

Objective To review the experience of manegement of cardiopulmonary bypass （CPB） in 82 elderly patients. Methods From January 2002 to December 2005, 82 elderly patients underwent CPB. There were 43 males and 39 females,aged from 60 to 77 years. With whole systemic anesthesia,myocardial protection performed using blood cardioplegia. High perfusion flow 2.0-2.6 L · m^2-1 · min^-1 ,mean arteria pressure 60-90mm Hg and ultrafiltration technique were used during CPI3. Results CPB time was 48-335min,aortic cross -clamp time 25-230min. One of the patients died during surgery, The others recovered. Conclusion It was effective that using membrane oxygenation, keeping high perfusion flow and mean arteria pressure, performing myocardial protection with blood cardioplegia, using ultrafiltration at time and protecting important organ .