老年心脏手术体外循环管理

Management of extracorporeal circulation during heart operation in elderly patients

目的探讨老年心脏手术体外循环技术。方法分析我院近两年65例70岁以上患者,体外循环中中度血液稀释,应用康斯特保护液(HTK)一次灌注进行心肌保护,部分应用4∶1冷血停搏液顺灌-开放升主动脉前温血灌注心肌。灌注中采用中高流量2.4～2.8 L/(m2.min),维持血流动力学稳定。结果体外循环时间42～406 min,主动脉阻断时间22～186 min,心脏自动复跳43例,自动复跳率66.1%。术后死亡6例,59例患者痊愈出院。结论针对不同的患者选择个性化灌注方案,加强围术期体外循环管理及重要器官保护,及时应用主动脉内球囊反搏及体外膜肺支持技术,可显著减少并发症,提高手术成功率。

Objective To investigate the technology of extracorporeal circulation （ECC） in elderly patients. Methods 65 cases over 70 years in last 2 years were retrospectively analyzed. Moderate hemodilution was used during ECC. A single dose of Histidine -Tryptophan - Ketoglutarate （HTK） solution as cardioplegia was applied in a part of patients. In other part of cases, 4：1 cold blood cardioplegia antegrade perfusion and subsequently one time of warm blood cardioplegia perfusion was applied before ascending aorta clamp was removed. During operation, a moderate to high perfusion rate was chosen as 2.4 -2.8 L/（ m2 ·min） to maintain the stabi- lization of circulation dynamics. Results The duration of ECC ranged from 42 to 406 minutes. The aorta cross - clamping time ranged from 22 to 186 minutes, and 43 （66.1%） patients＇hearts automaticly rebeated. After operation 6 patients died, other 59 patients re- covered and discharged uneventfully. Conclusion The personalized perfusion plan should be chosed in view of different patient. The strengthening of perioperative ECC management, the protection of important organs and prompt application of intra - aortic balloon pump （IABP） and extracorporeal membrane oxygenation （ECMO） could obviously reduce the complication and raise the ratio of suc- cessful operation.