心脏不停跳心内直视手术体外循环管理

EXTRACORPOREAL CIRCULATION MANAGEMENT DURINGOPEN HEART OPERATION WITHOUT CARDIOPLEGIA

目的：总结和评价心脏不停跳心内直视手术时体外循环管理对心肌的保护作用。方法：３２１例先天性心脏畸形矫治、二尖瓣换瓣、粘液瘤摘除等体外循环下手术，用无血生理盐水预充液，中度血液稀释，转流中不阻断主动脉，只阻断腔静脉，维持心脏缓慢（４０～６０次／ｍｉｎ）窦性节律空跳下手术。鼻咽温度３３～３４℃。灌注流量７０～９０ｍｌ／ｋｇｍｉｎ－１。结果：心脏操作完毕无需复跳，很快可脱离体外循环机，腔静脉平均阻断时间（３１．５±８）ｍｉｎ，转流平均时间（５８．４±１５．６）ｍｉｎ，多巴胺平均用量０．６μｇ／ｋｇｍｉｎ－１，ＭＡＰ７．２～９．５ｋＰａ。血流动力学稳定，脑氧饱和度正常，心肌酶测定ＣＫ－ＭＢ异常＜０．８％，术中无死亡，术后死亡７例，死亡率２．１８％，其余康复出院，无脑神经等并发症。结论：心脏不停跳体外循环心内直视手术的方法可提供接近生理的心肌保护效果。

Objective:TO summarize and assess the effect of extracorporeal circulation mangement during open heart operation without cardioplegia on piotection of myocardial yunctin Methods:321 operatoins of correcting of congenital heart malformation mitral valve replacement,myxoma extraction had been undergone extracorporeal circulation.The 0 9%NaCl and plasma substitutes salt solution had been choosen as preliminary solution,moderate hemodilution,no blockade of aorta during bypass;clamp the vena cavae,maintening teart beat(40￣60beats/min)under slowly sinus rythm,nasopharynx temperature at 33￣34℃,perfusion flow at 70￣90ml/kg.min -1 had been used in extracorporeae circulation managment.Results:At end of heart opretion,there are no resuscitation process,steply extracorporeal circulation machines,can be remove easily, blockage vena cavae are (31.5±8) min,mean bypass time are(58 4±15 6)min,average dopamine dosage are 0 6 μg/kg min -1 ,MAP are 7 2￣9 5 kPa. There are a stable hemodynamics and normal cerebral oxygen saturation.Abnormal myocardial enzyme CK MB were less than 0 8%.No death during the operation,7 cases died during postoperative period.The mortality were 2 8%.The others patients were recovered smosthly.There are nocerebral ischemic complication.Conclusion:These methodl of extracorporeal circulation managment during open heart operation without cardioplegia can provided an more physiologic myocardial protection effect and can be used in clinical practice.