体外循环心内直视手术经冠状静脉窦逆行灌注14例分析

ANALYSIS OF 14 CASES OF OPEN HEART SURGERY UNDER CPB WITH CORONARY SINUS RETROGRADE PERFUSION

对１４例风湿性心脏病病人行心脏瓣膜置换术，手术在心脏不停跳的状态下完成，术中应用自行设计的灌注装置经冠状静脉窦逆行灌注，灌注流量为０．２５～０．５Ｌ／ｍｉｎ，灌注压力为４．６７～８．０ｋＰａ，麻醉与灌注满意，阻断主动脉前后的血气酸碱分析、电解质和心肌酶的测定无明显变化，术后无多巴胺等正性肌力药物依赖和严重心律失常，病人恢复良好。提示经冠状静脉窦逆行灌注方法具有良好的心肌保护作用。

Valve replacement was performed in 14 cases of RHD under general anesthesiaand CPB A perfusion device designed by the authors was used for coronary sinus retrograde perfusion The perfusion flow was 0 25～0 5 L/min and the perfusion pressure was 4 67～8 0 kPa The aortic valve,mitral valve or both valves replacement was accomplished with the heart kept beating Anesthesia and perfusion were satisfactory during the operation The blood gas,acid base,electrolytes and myocardial enzymes determinations did not change significantly before and after clamping of the aorta There were no dopamine dependence and severe arrhythmia after the operation All patients recovered smoothly Our result indicates that the above mentioned technique is effective for myocardial protection