65岁以上老年患者心脏瓣膜手术中的体外循环管理

Extracorporeal circulation management in heart valve replacement of old patients over 65 years

目的总结65岁以上老年人心脏瓣膜置换术的体外循环管理方法。方法回顾性分析2006年1月至2008年12月老年人心脏瓣膜置换术232例患者的临床资料,着重分析体外循环方法和手术方法。全部患者采用气管插管、静吸复合麻醉,中度血液稀释、中度低温、中高流量,冷含血停跳液进行心肌保护,全部应用超滤器。结果体外循环时间(87.2±32.7)min;主动脉阻断时间(58.3±27.5)min。转流中平均动脉压维持在60～90mm Hg(1mm Hg=0.133kPa),超滤量为800～8300mL,心脏自动复跳率86%,本组早期死亡10例(4.3%)。结论体外循环中加强心肌保护;控制血液稀释度,使用血液超滤技术维持机体内环境的稳定;有效的组织灌注以及良好的保护等综合性措施,有助于脑、肾、肺等重要脏器的保护,有利于提高老年患者心脏瓣膜置换术中体外循环的质量,并确保手术安全。

Objectives To summarize the experience of extracorporeal circulation in old patients with heart valve disease.Methods We retrospectively analyzed the clinical data of 232 patients aged from 65 to 78 years old,weighting from 37 to 87 kg,underwent valvular surgical procedures from Jan.2006 to Dec.2008.All patients were administrated with combined intravenous and volatile anesthesia.Management of extracorporeal circulation including medium hemodilution,medium to high flow,cold blood cardioplegia and ultrafiltration were applied in each patient.Results The mean bypass time was （87.2±32.7） min.Mean cross-clamp time was （58.3 ±27.5） min.Mean arterial pressure was maintained from 60 to 90 mm Hg（1 mm Hg=0.133 kPa） during bypass.The rate of automatic heart beating after cross- clamp removing was 86% .The early mortality was 4.3% .Conclusions To improve the quality of extracorporeal circulation in old patients over 65 years old during valular surgical procedures,the comprehend managements including hemodilution,organs protection,ultrafiltration and effective tissue perfusion are important.