心内直视手术体外循环搏动灌注的临床应用

A Clinical Practice on Pulsatile Perfusion During Extracorporeal Circulation In Open Heart Surgery

目的 观察心内直视手术体外循环搏动灌注与平流灌注的区别。 方法 将１００ 例心内直视手术患者，按灌注方法不同分为搏动灌注组与对照组，每组各 ５０ 例，分别采用搏动灌注法与平流灌注法。于转流前、转流３０ 分钟、６０ 分钟、９０ 分钟和升主动脉开放时，分别测量血浆游离血红蛋白、血小板计数，记录术中尿量，术中、术后血红蛋白尿例数，肢体末梢皮肤温度恢复时间，正性肌力药物应用时间；观察术后引流量，记录术后呼吸机应用时间和心脏自动复跳例数等，然后进行对比观察研究。 结果 搏动灌注组心脏自动复跳率提高，术中尿量增多，术后正性肌力药物应用时间减少，肢体末梢皮肤温度较对照组提前恢复２～３ 小时，提前拔气管插管６～１０ 小时，转流中血小板两组无差异；血浆游离血红蛋白随搏动时间延长逐步增高，术中、术后血红蛋白尿例数有所增加，但两组无差异；术后渗血引流量两组无差异。 结论 搏动灌注方法较符合生理状况，明显优于平流灌注方法。

Objective To observe the difference between pulsatile perfusion and continuous nonpulsatile flow perfusion during extracorporeal circulation in open heart surgery. Methods One hundred patients with heart disease were divided into two groups:Group of pulsatile perfusion and group of continuous nonpulsatile flow perfusion.Using pulsatile perfusion and continuous nonpulsatile flow perfusion during extracorporeal circulation in each of 50 patients undergoing open heart surgery comparison of the clinical results was made between the two groups. The serum free hemoglobin, blood platelet count at 30 minutes before bypass, 30 minutes, 60 minutes, and 90 minutes after bypass were tested respectively. The urine output during operation, the number of patients with hemoglobinuria during and after operation, the skin temperature recovery time of distal end of the lower limb, together with using positive muscle drugs and respirator and drainage with measuring the amount of after operation were all recorded. Results In the pulsatile perfusion group the spontaneous rebeating rate increased, the urine output during operation increased, the time of skin temperature recovery was 2 3 hours earlier than that of the continuous nonpulsatile flow perfusion group; the time of tracheal detubation was 6 10 hours earlier than that of the continuous nonpulsatile flow perfusion group. There was no significant difference in blood platelet count during bypass and the blood drainage after operation between the two groups. The serum free hemoglobin, the hemoglobin in urine during and after operation steadily increased with the lengthend pulsatile time, but there was no significant difference between two groups. Conclusion The pulsatile perfusion coincides with the physiologic demand and shows more advantadges than that of continuous nonpulsatile flow perfusion.