浅低温不停跳体外循环方法在重症搭桥手术中的应用

The application of mild hyperthermia extracorporeal circulation in coronary artery bypass grafting for severe coronary artery disease patients

目的:总结重症患者在浅低温不停跳体外循环(extracorporeal circulation,ECC)下行冠状动脉旁路移植手术的效果。方法:2010年1月至2011年5月对34例择期行冠状动脉旁路移植术(coro-nary artery bypass grafting surgery,CABG)的重症患者(左主干病变、左心室舒张末期内径>60 mm、左心室射血分数<40%、术前Euroscore评分>6分、术前心源性休克、急性心肌梗死)施行浅低温ECC下不停跳CABG,术前均存在不稳定型心绞痛。其中10例(28%)合并糖尿病。3例(44%)患者术前应用了主动脉内球囊反搏(intra-aortic ballon pump,IABP)。分析总结重症CABG患者体外循环管理经验。结果:平均ECC时间68 min(42～123 min),机械通气时间平均18 h(6～84 h),ICU滞留时间平均2 d(14h～14 d),住院时间平均22 d(10～34 d)。12例患者术后应用IABP。无与ECC相关的神经系统并发症,肾功能不全6例(18%),并应用肾替代疗法。死亡2例(6%)。结论:对严重心功能不全或血管条件不好的重症CABG患者,采用浅低温不停跳ECC是一种安全可靠的手术方法。

Objective：To summarize the clinical characteristics of coronary artery bypass grafting in 34 patients with severe coronary artery disease under mild hyperthermia extracorporeal circulation.Methods：34 consecutive patients with Left main disease、LVEDD〉60 mm、EF〈40%、Euroscore〉6、heart failure or AMI,were scheduled for beating heart CABG under mild hyperthermia extracorporeal circulation.All 34patients had unstable angina,10（28%）patients had diabetes,15（44%）patients had old myocardial infarction and 15（44%）patients were referred to Intra-aortic ballon pulsation（IABP） pre-operative.Results：There are2（6%）died.The mean ECC time is 68 min（42-123 min）,mean ventilation time is18 h（6-84 h）,mean ICU stay time is 2 days（10-34 d） and hospitalization time is 22 d（10-34 d）.We had12 patients inserted IABP post-operative,only 3 pre-operative.No patient suffered nervous system related complications but 6（18%） patients had renal failure and applied ranal replace therapy.Conclusion：Beating heart CABG under mild hyperthermia extracorporeal circulation is safe and reliable for CAD patients with impaired left ventrical function or poor target vessels.