心脏不停跳心内直视手术对心肌保护的临床研究

Clinical research of beating heart intracardiac surgery on the myocardial protection

目的评价体外循环下不阻断升主动脉行心内直视术对心肌保护作用。方法静脉吸入复合全身麻醉,胸骨正中切口,按常规建立体外循环。对手术不涉及主动脉瓣的患者,采取不阻断升主动脉的方法保持心肌有氧灌注,在并行循环或心室颤动下进行心内手术操作。回顾性分析2004年7月￣2007年10月,76例应用此法手术的心脏病病例的临床资料。全组男48例,28女例,平均年龄(35.65±1.34)岁,平均体重(40.61±3.72)kg。病种包括风湿性心脏病二尖瓣病变6例,先天性心脏病室间隔缺损15例,房间隔缺损36例,法洛三联征2例,肺动脉瓣狭窄7例,动脉导管未闭10例。全组均在浅低温心脏跳动下完成手术。结果全组无脑气栓发生,全组无死亡。结论不阻断升主动脉,浅低温体外循环心脏不停跳下心内直视术用于心脏病治疗,心肌保护安全有效,临床效果满意。

Objective To evaluate the effect of no aortic clamping on myocardiac protection with cardiopulmonary bypass（CPB）during intracardiac surgery.Methods All patientswere performed beating heart surgery under hypothermic cardiopulmonary bypass drough incision of mid-sternal line, with vein and inhalation combined anesthesia,ascending aorta not clamped,and myocardium infused continuously by oxygenated blood.From July 2004 to December 2007,76 cardiopaths were underwent intracardiac surgery using the technique of no aorta-clamping under CPB.They were 48 males and 28females.Their age mean （35.65±1.34）years.Their weight mean （40.61±3.72）kg.The cardiac disease including ：the mitral lesion of rheumatic heart disease in 6,ventricular septal defects in 15,atrial septal defects in 36,Trialogy of Fallot in 3,pulmonary stenosis in 7and PDA in 10.All intracardiac surgery was performed under mild hypothermic CPB with beating hearta.Results No cerebral embolism was found and no deaths.Conclusion Intracardiac surgery without aortic-cross clamping in cardiac disease is afeasible,effective and safe technique for myocardial protection during CPB.