心脏瓣膜替换术体外循环搏动性血流灌注临床应用研究

A Clinical Practical Study on Pulsatile Flow Perfusion During Cardiopulmonary Bypass in Valve Replaced Operation

本文报道心脏瓣膜病二尖瓣替换或二尖瓣加主动脉瓣双瓣膜替换术６５例，用双盲法选择病例，其中体外循环搏动性血流灌注３３例，平流灌注３２例，两组比较：搏动组心脏自动复跳率明显提高，术中尿量明显增加，术后用呼吸机时间明显缩短，差异有极显著性（Ｐ＜００１），肢体末梢皮肤温度恢复时间提前，应用心肌正性肌力药例数，时间明显减少，两组差异明显（Ｐ＜００５），血红蛋白尿例数有所增高，血小板计数（ＰＣ）及术后引流量差异无显著性（Ｐ＞００５），随搏动时间的延长，血浆游离血红蛋白呈进行性增高，平均每３０ｍｉｎ增高６ｍｇ，差异有非常显著性（Ｐ＜００１）。研究证明搏动性血流灌注明显优于平流灌注。

Operative efficacy of 65 patients with mitral valve replaced or double valve replaced under cardiopulmonary bypass was reported. 33 patients perfused by pulsatile flow and 32 patients perfused by nonpulsatile flow were observed.The results showed that as compared with nonpulsatile perfusion group,the spontaneous rebeating rate elevation,the urine quantity in operation was increased,the time of using respiratory machine was shortened significantly in the pulsatile perfusion group,there was significant difference between the two groups( P <0 01).The time and the number of patients taken drugs of myocardial positively inotropic action were reduced obviously in the pulsatile group,the terminal limbs temperature recovered earlier in the pulastile perfusion group than that of the nonpulsatile perfusion group,and also significant difference( P <0 05).The number of cases of hemoglobin urine and the urinary output increased,the platelet count decreased in the group of pulsatile perfusion than that of nonpulsatile perfusion,but no significant difference between the two groups( P >0 05).The plasma free hemoglobin(Hb) increased with the prolongation of pulsatile perfusion time.The mean value of plasma Hb was increased by 6 mg every 30 minutes,there was significant difference between the two groups( P <0 01).The data suggest that the pulsatile perfusion is obviously superior to nonpulsatile perfusion.