心脏二次手术的体外循环体会

Experience of extracorporeal circulation of secondary cardiac surgery

目的总结心脏二次手术的体外循环(ECC)管理体会。方法实施心脏二次手术患者15例,其中经升主动脉-上下腔静脉插管10例,股动-静脉插管4例,升主动脉-腔房管1例。均在浅中低温下行体外循环。15例均采用4∶1氧合血心肌保护液。结果体外循环时间超过120 min 6例,心脏自动复跳8例,除颤后复跳7例。术中行超滤10例。术后1例因脑出血死亡,2例自动出院,其余均治愈出院。结论二次手术患者具有病史长,病情重,心功能差,ECC时间长等特点,采取综合的心肌保护措施,加强血液保护,及时的超滤是心脏二次手术的ECC管理的关键。

Objective To sumarize the experience of extracorporeal circulation （ECC） in 15 cases of secondary cardiac sur- gery. Methods There were 15 cases of secondary cardiac surgery altogether. 10 cases were performed with cannulas inserted from the ascending aorta to the inferior and superior vena cava, while 4 .cases performed from the femoral artery to the femoral vein, 1 case from the ascending aorta to the right atrial. All of these surgeries were performed in mild and moderate hypothermia. All of these cases were performed with 4：1 oxygenated blood myocardial protection solution. Results The ECC time was more than 120 min in 6 cases. And heart resuscitation automatically in 8 cases, and with defibrillation in 7 cases. Uhrafahration were used in 10 surgeries. 1 patient died of cerebral hemorrhage after operation. 2 patients discharged ahead of schedule, and the rest were cured. Conclusion Takeing compre- hensive measures to enhance myocardial protection, strengthening blood conservation, timely ultrafihraion in the extracorporeal circula- tion are the key to the secondary cardiac surgery, because of these patients＇long history of disease, poor cardiac function, and long ECC time.