体外循环浅低温心脏不停跳心内直视手术的临床研究

Open-heart surgery with cardiopulmonary bypass circulation under mild hypothermia

目的:探讨体外循环浅低温心脏不停跳心内直视手术的方法、疗效评价及其对心肌保护作用。方法:总结2004年3月～2008年12月间12例施行浅低温心脏不停跳心内直视手术病例,并行循环不阻断主动脉,鼻咽温维持在32～35℃,阻断上、下腔静脉,完成心内直视手术。结果:全组无围手术期死亡,心脏手术结束能顺利停机,术后血流动力学平稳,无严重心律失常,血尿发生率0%,无1例发生空气栓塞。1例心房切口缝合针眼渗血,行再次开胸止血,1例术后第32h发生急性肺梗塞,均经治疗痊愈。结论:浅低温心脏不停跳心内直视手术技术安全可行,是一种接近生理状态的心肌保护方法,可避免再灌注损伤,有较理想的心肌保护效果。

Objective：To examine the approaches to open-heart operation with extracorporeal circulation under mild hypothermia. Methods：The clinical data were reviewed in 12 patients undergone openheart surgery by this approach between Mar. 2004 and Dec. 2008 in our hospital. Results ： No perioperative death occurred. After removal of the cardiopulmonary bypass unit, the patients recovered to smooth general circulation, with no complications of serious cardiac arrhythmias, hematuria or aeremia. Only 1 case occurred bleeding around the suture of the atrium and required second intervention. Another 1 complicated with acute pulmonary infarction 32 hours after the surgery, but was cured. Conclusion ： The open-heart operation with cardiopulmonary bypass circulation under mild hypothermia is sound and safe and may protect the myocardium from injury due to reperfusion.