浅低温、不停跳心内直视手术的麻醉和体外循环管理

Anesthesia and management of cardiopulmonary bypass during beating heart surgery under mild hypothermia

目的:探讨心内直视手术时不阻断主动脉、心脏不停跳的体外循环(CPB)和麻醉管理。方法:160例拟行心内直视手术的患者随机分为浅低温心脏不停跳组(观察组)和停跳组(对照组),各80例。所有病例采用综合血液保护措施。观察和分析各组患者一般情况、麻醉管理、体外循环时间、麻醉恢复和预后等指标。结果:两组患者平稳完成体外循环,最后均痊愈出院。观察组病人体外循环时间短,术后无严重并发症,苏醒及拔管时间明显缩短。两组自身输血42例(26.2%),未用库血共55例(34.3%)。结论:浅低温、心脏不停跳下的心内直视手术安全可靠,能实现心肌的良好保护,加之综合血液保护措施,能显著减少手术相关并发症,患者恢复快,住院时间短,费用降低。

Objective： To explore the anesthesia and management of eardiopulmonary bypass （CPB） during beating heart surgery under mild hypothermia without aortic occlusion. Methods ： 160 patients undergoing open heart surgery were randomly divided into observation group whose hearts were still beating under mild hypothermia and cardioplegia group （control group）. Each group had 80 cases and all eases received integrated blood conservation treatment. The indexes including patients＇general conditions, anesthesia management, cardiopulmonary bypass time, anesthesia recovery, prognosis etc. were observed and analyzed. Results： Patients in both groups experienced a smooth completion of eardiopulmonary bypass and discharged due to full recovery. The cardiopulmonary bypass time, awareness time and time for extubation in observation group were significantly shorter than those in the control group, without serious postoperative complications. In addition ,42 cases （26.2%） accepted self- blood transfusion in both groups,and 55 cases （34.3%） did not accept bank blood transfusion. Conclusion：The beating heart surgery under mild hypothermia is safe, reliable and able to achieve good myocardial protection. Combined with integrated blood conservation treatment, this method can significantly reduce surgery - related complications with a quick recovery, short hospitalization time, and low treatment costs.