浅低温体外循环心脏不停跳心内直视术

Open heart surgery performed in beating heart under light hypothermia and cardiopulmonary bypass

介绍浅低温体外循环心脏不停跳心内直视术。方法：自１９９３年７月～１９９９年６月，经正中或 前外胸切口，在浅低温体外循环心脏不停跳下行心内直视术１４３例，其中房间隔缺损６７例，室间隔缺损３５例，部 分性房室共同通道１６例，法乐三联症１３例，肺动脉瓣狭窄成形术７例，二尖瓣关闭不全成形３例，二尖瓣替换术 ２例。结果：全组平均体外循环时间４２．３ｍｉｎ，平均腔静脉阻断时间为３１．５ｍｉｎ，术后恢复良好，无低心排、严重心 律失常、栓塞及脑部并发症，全部治愈。结论：浅低温体外循环心脏不停跳心内直视手术有更好的心肌保护作 用，可广泛用于包括左右心系统相通的许多心内手术及二尖瓣替换术等。此技术的主要环节是预防术中心室纤 颤和动脉气栓。

To introduce the technique of open heart surgery performed in beating heart under light hypothermia and cardiopulmonary bypass. Methods: From July 1993 to June 1996, 143 cases of open heart surgery were performed in beating heart and cardiopulnomary bypass through median sternotomy or anteriolateral thoracotomy in our department including 67 cases of ASD, 35 cases of VSD, 16 cases of partial atrioventricular canal, 13 cases of trilogy Fallot, 7 cases of pulmonary stenosis, 3 cases of mitral regurgitation (mitral plasty), 2 cases of rheumatic heart disease (MVR). Results: Mean break time of vena cava is 31.5 min, mean CPB time is 42.3 min. All recovered well after operation without low output syndrome, severe arrchythmia, arterial embolism or brain complications. All are cured. Conclusion: Myocardial protection: Myocadial protection is good in open heart surgery performed beating under light hypothermia and CPB. The technique can be used widely in open heart surgery of heart diseases with left-right shunt as well as MVR in rheumatic heart disease. The key point of the technique is to prevent ventricu lar fibrillation and arterial air embolism.