全密闭式管路在心肺转流中应用10例分析

Clinical Analysis of Total Closed Circuit in 10 Cases of Cardiopulmonary Bypass

目的探讨全密闭式管路在心脏手术心肺转流(cardiopulmonary bypass,CPB)中应用的效果。方法将常规CPB管路改为全密闭式管路,10例心脏手术在CPB中使用滚压式血泵,采用密闭式管路的管理方法,观察该方法在操作中对血流动力学的影响,对手术配合的影响,以及能否简化机器的管理,增加安全性。结果全密闭式管路预充量少,血液稀释少,操作简单、安全,容易管理。与常规CPB方法相比较,本组病例在转流开始后血流动力学均较为稳定,表现为血压波动少,容易维持出入血平衡;转流中不同手术对该方法的影响较大,术中出血较少的4例冠状动脉搭桥术(coronary artery bypass grafting,CABG),较易维持转流中的平稳,出入平衡,血压稳定,可简化机器的管理,无需一刻不停地注视氧合器血平面;而其他术中出血多,心内外回收血较多的二尖瓣瓣膜置换术(MVR)和主动脉瓣瓣膜置换术(AVR),则转流期间需经常补充体内失血量,增加机器管理的难度。结论全密闭式管路的管理方法可用于心脏手术的CPB,但较适应于出血少的CABG,对术中出血多,心内外回收血较多的手术仍以常规CPB管理方法为好。

OBJECTIVE To observe the clinical effects of total closed circuit in cardiopulmonary bypass（CPB）.METHODS In 10 cases of CPB with roller pump,total closed circuit modified from the normal routine circuit was used to observe its security and benefits.RESULTS There were some merits of total closed circuit in CPB： less volume of priming,less hemodilution,simple manipulation and more security.Compared with normal circuit,stable hemodynamic was present in total closed circuit,especially in four cases of coronary artery bypass grafting（CABG）,the balance of blood both return and output easily made and the management of the perfusion was simplified.But in heart valve replacement surgery,manipulation of total closed circuit was more complicated because of large amounts of blood returning to the reservoir from the left ventricle and surgical field.CONCLUSION Total closed circuit can be securely used in cardiac surgery with CPB,but it＇s more suitably for CABG.