负压辅助静脉引流技术在微创心脏手术中的应用

Application of Vacuum-Assist Venous Drainage Technology in Minimally Invasive Cardiac Surgery

目的总结在微创心脏手术(M ICS)中应用负压辅助静脉引流(VAVD)技术进行体外循环(CPB)的方法及经验。方法2007年1月至2008年10月完成微创心脏手术的CPB 73例,其中使用达芬奇机器人(da vinc i S)完成心脏手术71例,经右侧胸小切口心脏手术2例。1例二尖瓣成形手术患者经股动脉、股静脉插管建立CPB,1例小切口房间隔缺损修补患者经股动脉、股静脉及上腔静脉插管建立CPB,其余71例手术均经股动脉、股静脉及颈内静脉插管建立CPB。CPB采用浅低温、中流量灌注,应用VAVD(负压控制在-30^-60 mmHg),连续血气监测(CD I-500)及超滤。结果73例患者CPB时间45~206(116.1±35.5)m in,升主动脉阻断时间27~132(58.5±23.6)m in,CPB转流中尿量200~1 900(825.5±447.5)m l,超滤量800~4 800(2571.1±885.9)m l,9例患者CPB液体量为零平衡,53例患者CPB液体量为负平衡200~2100(835.8±524.0)m l,术后呼吸机辅助时间7~17(11.1±4.3)h,术后24 h引流量120~680(247.6±197.5)m l,全组病例均顺利停机,无并发症出院。结论VAVD技术能获得充分的静脉引流,在微创心脏手术CPB中必须使用VAVD才能保证良好的静脉引流。在保证充足的灌注流量的前提下,可以尽量多的滤出液体,达到零平衡或负平衡的目的,VAVD是一项安全有效的技术。

OBJECTIVE To summarize the management of cardiopulmonary bypass （CPB） with the technique of vacuum- assist venous drainage （VAVD） in the minimally invasive cardiac surgery （MICS）. METHODS Total 73 patients underwent MICS, including 71 cases undergoing cardiac surgery with da vinci S robotic surgical system, 2 cases undergoing minimally invasive thoracotomy. The CPB for most of patients was achieved with femoral arterial cannnla, femoral venous cannula and right internal jugular venous cannula, except for 1 patient undergoing MVP with femoral arterial cannula, femoral venous cannula and 1 patient undergoing ASDR with femoral arterial cannula, femoral venous cannala and superior vena cava eannula. VAVD was used for all cases during CPB, and the vacuum negative pressure of -30 ～ - 60 mmHg was administered to the closed cardiotomy reservoir. RESULTS For all patients, CPB time was 45 - 206 （116.1 ± 35.5 ） min and aortic cross- clamp time was 27 -132 （58.5 ± 23.6） min respectively during CPB, the urine volume was 200 - 1 900 （825.5 ±447.3） ml, ultrafiltratiou volume was 800 ～4 800 （2571. 1 ±885.9） ml,and the total fluid balence was subzero -balenced（ 53 cases） or zero -balenced （9 cases） in most patients. The postoperative ventilation surpporting time was 7 - 17 （11.1 ±4.3） h and drainage volume within 24 h post - operatively was 120 -680 （247.6 ± 197.5） ml. CONCLUSION Using VAVD technique in MICS can ensure satisfactory vena eava drainage, reducing the CPB fluid volume maximally. VAVD is a safe, simple and effectively technique for MICS.