补片法控制心脏直视手术中难治性出血七例临床分析

Clinical analysis of 7 cases of Patch-skiU for controlling refractory bleeding in open heart surgery

目的探讨补片法控制心脏直视手术中难治性出血的临床价值。方法2007年5月至2008年10月我院共发生心脏直视手术中难以控制的活动性出血7例，采用新鲜自体心包片（6例）或涤纶片（1例）作为修补材料，用5-0 Prolene线连续缝合进行控制，对止血效果进行分析。结果本组7例术后24h心包纵隔引流量均不超过500ml，未再发生活动性出血，无胸骨和纵隔感染发生，均痊愈出院。结论补片法可以有效控制心脏直视手术中难治性出血。自体心包片有很多优点，应尽量采用心包片作为补片材料，如果心包组织有水肿或感染等，涤纶片可以作为次选材料。

Objective To evaluate the effects of＇patch-skill＇in the management of refractory bleeding during the process of open heart surgery. Methods Between May 2007 to October 2008,7 patients undergoing open-heart surgery experienced active bleeding. Autologous pericardial patches were used in 6 patients, and polyester patch in the other one. The patches were sutured continuously by 5-0 Prolene suture. Results The 24 hour chest tube output was less than 500 ml in all 7 cases after operation. There were no death, secondly active bleeding, or mediastinal infection. Conclusion The＇patch-skill＇ can effectively control the refractory bleeding during open heart surgery. Autologous pericardial patche is the first choice because it has multiple advantages. The polyester patch can be used alternatively when autologous percardium cannot be used （for various reasons such as edema and infection）.