体外循环深低温技术在外科手术中的应用

Application of deep hypothermic extracorporeal circulation technique in surgical procedures

目的探讨深低温体外循环技术（DHCC）在外科手术中的应用及其管理方法。方法1997年12月-2007年12月解放军总医院共54例患者应用DHECC技术,其中大血管手术34例,复杂先心病10例,颅内巨大基底动脉瘤5例,腹部肿瘤伴右房或下腔静脉瘤栓5例。建立体外循环的动脉灌注采用升主动脉（n=25）、腋动脉（n=18）、股动脉（n=11）途径,静脉引流采用上下腔静脉插管（n=21）、右腔房管（n=25）、股静脉（n=8）途径。对其临床资料进行回顾性分析,包括体外循环的建立方法、时间、温度、流量及应用效果等。结果术中通过不同部位插管建立体外循环,应用含血心肌保护灌注34例（62.96%）,脑保护灌注7例,超滤技术49例。体外循环时间63~414（178.6±74.4）min,46例主动脉阻断时间16~259（123.4±52.2）min,43例停循环时间2-109（30.0±22.4）min,最低鼻咽温13.6-25.7（19.61±3.40）℃,最低肛温15.2-30.5（21.58±3.63）℃。自动复苏36例（66.7%）。术后早期死亡4例（7.4%）。结论DH ECC不仅可为外科手术提供无血或少血、较为清晰的手术野,也可用于常规方法不易完成的复杂手术,有助于手术的顺利完成。

Objective To explore the application and management of deep hypothermic extracorporeal circulation （DHECC） in surgical procedures. Methods From Dec. 1997 to Dec. 2007, DHECC was applied in 54 patients suffered from great vessel diseases （34/54）, complex congenital heart disease （10/54）, giant basilar artery aneurysm （5/54）, and abdominal tumor with tumor embolus intruding into right atrium or inferior vena cava （5/54） in the General Hospital of PLA. Extracorporeal circulation was performed with arterial perfusion by ascending aorta （n=25）, axillary artery （n=18） and femoral artery （n=11）, and venous drainage by superior vena cava and inferior vena cava （n=21）, right atrium （n=25）, and femoral vein （n=8）. Clinical data were analyzed retrospectively including extracorporeal circulation （ECC） time, aortic clamping time, deep hypothermic circulation time, the lowest temperature, and the use of ultrafiltration. Results The ECC time was 63-414 （178.55±74.42）min. Aortic clamping time was 16-259 （123.39±52.21） min in 46 patients. Deep hypothermic circulatory arrest （DHCA） was performed in 43 patients, and the duration was 2-109 （30.00±22.37）min. The lowest nasopharyngeal temperature was 13.6-25.7 （19.61±3.40）℃, and the lowest rectal temperature was 15.2-30.5 （21.58±3.63）℃. Ultrafiltration technique was used in 49 cases. 36 of 54 cases （66.7%） self-awakened. Four cases （7.41%） died in the early post-operation period. Conclusion The DHECC can offer a clear and exsanguinated operating field, and is helpful to execute complicated or major operations which are hard to complete with common techniques.