浅低温体外循环心脏跳动中心内直视手术1032例临床分析

Clinical analysis of on-pump, beating-heart intracardiac procedures in 1 032 cases

目的 探讨完善浅低温体外循环心脏跳动中心内直视手术技术 ,报告 1 0 32例临床应用经验。方法 1 997年 1 1月至2 0 0 0年 9月间 ,改良浅低温体外循环心脏跳动中心内直视手术技术 ,建立同期左心房左心室引流和综合序贯排气技术 ,改善手术野显露 ,完善术中排气。应用该技术实施心脏手术 1 0 32例 ,男 5 0 3例 ,女 5 2 9例。其中先天性心脏病 71 4例 ,心脏瓣膜病 31 8例。结果全组手术死亡率为 2 .33% (2 4/1 0 32 ) ,其中先天性心脏病手术死亡率 2 .7% (1 9/71 4) ,心脏瓣膜病手术死亡率为 1 .6 % (5 /31 8)。全组无体循环气栓和永久性房室传导阻滞发生。结论 浅低温体外循环心脏跳动中心内直视手术技术安全可行 ,可有效减轻低温和缺血再灌注对心肺等脏器的损伤作用 ,有利于避免术中心脏传导阻滞的发生。

Objective To improve intracardiac operation skills on bea ting heart with mild hypothermic cardiopulmonary bypass (On pump beating heart technique), and to review the clinical experience in 1 032 cases. Methods A total of 1 032 cases of intracardiac operations on pump beating heart from November 1997 to September 2000 were reviewed. Of them, 714 cases were congenital heart diseases (CHD), and 318 cases were valvular heart diseases (VHD). The technique was improved by establishing simultaneous left atrium and ventricle suction and integrating sequential de airing procedure. Results The operative mortality was 2.33% (24/1 032), the mortality was 2.7% (19/714) in cases with CHD, and 1.6% (5/318) in those with VHD. There was no patient complicated with systemic air embolism or permanent atrioventricular conduction block. Conclusion Results suggested that intracardiac procedures on pump beating heart with mild hypothermic cardiopnlmonary bypass is safe and available in patients with CHD or VHD. It might extenuate the heart and lung injury by hypothermia and ischemia reperfusion during cardiopulmonary bypass. Cardiac conducting block might be prevented during operation.