体外循环下不阻断升主动脉心内直视手术的临床研究(附558例报告)

Clinical study of the open heart surgery without clipping the ascending aorta ─ report of 558 cases

目的 对 5 5 8例患者在体外循环 (CPB)下不阻断升主动脉行心内直视手术的临床研究。方法 5 5 8例患者均常规建立体外循环 ,不阻断升主动脉 ,不做心脏停跳液灌注 ,转机后立即阻断上下腔静脉 ,其中 115例低体重复杂先心患者降温 ,使心脏完全停跳后行心内操作 ,余均在低温或常温心脏跳动下行心内操作 ;体外循环时间 8～ 135分钟 ,平均 36 .79分。结果 死亡 7例 ,余均痊愈出院。经术后 1～ 2年随访 42 8例 ,除 7例VSD(室间隔缺损 )有 <5mm的残漏外无其它并发症和后遗症。结论 该方法既简化了操作程序 ,又为重症复杂手术提供了充分的手术时间 ,减少了手术后的各种并发症 ,从根本上避免了心肌缺血和再灌注损伤的发生 ,促进了心功能的恢复 。

Objectives To 558 patients, the intra cardiac direct vision operation without clipping ascending aorta were evaluated. Method Routine cordiopulmonary bypass were set up in all of these patients without clipping ascending aorta, and without cardioplegic solution perfusion. When extra corporeal circulation pump began, clip both the supravena cava and infravena cava at once, 115 cases with low body weight and complex congenital cardiac disease were given hypothermia, to stop the heart beat, and then intra cardiac operation was undertaken. The intra cardiac operation in remanders were done under slight hypothermia or nomothermia without stooping heart beat. The mean of extracorporeal circulation time was 36.79 minutes (from 8 to 135 minutes).Results Of 558 patients, seven were died, The remainders were cured and discharged from hospital. Four hundred and twenty eight patients were followed 1-2years after operation, no any complication or sequela was defected except 7 ventricular septal defect patients. Still had remnant defect less than 5mm. Conclusion This method not only simplifies operation program, but also provided full time for severe patients and complicated operations, decrease the post operation complications; fundamentally prevent myocardial ischemia and reperfusion injury, and advantagiously promotes recovery of cardiac function. To patients with poor cardiac function before operation and severe complex congenital heart disease, the value of this method is more prominent.