重症心脏瓣膜置换术的体外循环管理

Extracorporeal circulation management of heart valve replacement patients

目的探讨重症心脏瓣膜置换术体外循环(Extracorporeal circulation,ECC)管理和心肌保护的方法。方法对28例重症心脏瓣膜置换术患者ECC采用中度低温,中度血液稀释,心肌保护为高钾含血停跳液灌注。结果体外循环时间56～235min,主动脉阻断时间42～173min,心脏停跳时间48～179min,术中灌注压50～80mmHg,心脏自动复跳22例,电击复跳6例,死亡3例,死亡率10.7%。结论良好的体外循环管理和综合性的心肌保护可提高重症心脏瓣膜置换术患者的救治率。

Objective To discuss the extracorporeal circulation （ECC） management and myocardial protection of heart valve replacement patients. Methods Mild hypothermia and hemodilufion was used for treatment of 28 patients underwent heart valve replacement. Results The periods of ECC lasted from 56-235 minutes. The aortas were crossclamped for 42- 173 minutes. The hearts were arrested for 48-179 minutes. Average arterial infusion pressure was 50-80 mmHg; There were automatic reheating in 22 cases; Electrical shock reheating in 6 eases. There were 3 death with a mortality of 10.7%. Conclusion Good extracorporedal circulation management and comprehensive myocardial protection would help increase the cure rate of severe heart valve disease patients underwent heart valve replacement.