心脏空跳中二尖瓣替换术的体外循环管理

Management of the Extracorporeal Circulation during Mitral Valve Replacement with Nonejection Beating Heart

目的观察浅低温体外循环（ＣＰＢ）不阻断主动脉，在心脏空跳状态下施行心内直视术对机体内环境的影响。方法二尖瓣替换术１４例，预充液以生理盐水为主，晶胶比为０．５２～０．７８，稀释后Ｈｂ６８～９６ｇ／Ｌ。心肺转流中维持鼻咽温（３３．１±０．９）℃，灌注流量（９４±２８）ｍｌ·ｋｇ－１·ｍｉｎ－１，灌注压（９．５±０．７）ｋＰａ。转流前、中、停机后３０ｍｉｎ，分别抽取动脉血测血气及血清电解质。结果转流中、停机后３０ｍｉｎ与转流前比较，动脉血气及血清电解质无显著变化。开放上下腔束带后（１０．９±４．９）ｍｉｎ均一次停机成功，术后无低心排、心包填塞及脑、肺、肾的并发症。结论浅低温ＣＰＢ不阻断主动脉，维持心脏空跳下心内直视术，有利于维护机体内环境的稳定，而且有良好的心肌保护作用。

Objective To observe the effect of open heart surgery on the internal environment of organism under superficial hypothermia cardiopulmonary bypass(CPB)with unclamped aorta and nonejection beating heart Methods Mitral valve replacement was performed in 14 cases,who received chiefly normal saline as priming fluid for CPB in which the proportion of crystal fluid to colloidal was 052￣ 078Hemoglobin concentrations were 68￣98g/L after hemodilutionTheir nasopharyngeal temperature was kept at 33109,perfusion flow at (9428)mlkg-1min-1 and perfusion pressure at (9507)kPa during CPBThe arterial blood gases and serum electrolytes were measured respectively before,during and after 30 minutes CPB Results The arterial blood gases and serum electrolytes during and after 30 minutes CPB showed no significant changes as compared with that before CPBIn all the cases,successful completion of CPB was brought about(10949)minutes after untying the bands around the superior and inferior venae cavaLow cardiac output and cardiac tamponade as well as cerebral,pulmonary and renal complications were not found after operation Conclusion Open heart surgery under superficial hypothermia CPB with unclamped aorta and nonejection beating heart is beneficial to the stability of the internal environment of organism and,moreover,it has good effect on myocardial protection