不停跳心脏直视手术的体外循环探讨

Cardiopulmonary Bypass of Cardiac Surgery With Mild Hypothermia and Beating Heart

目的:本文总结了浅低温不停跳心脏直视手术的体外循环管理经验。本院在1999年10月至2000年11月间共施行了浅低温不停跳冠状动脉搭桥术36例。其中男性32例,女性4例,年龄59±17岁,体表面积1.76±0.24 M^2,心功能3.6±0.4级。皆因左冠状动脉前降支、回施支和右冠状动脉主支狭窄而接受冠状动脉旁路移植手术。术中保持患者鼻咽部温度30～34℃。不阻断主动脉,不灌注停搏液,在心脏慢跳(心率60次/分钟左右)、空跳的状态下完成手术操作。患者均安返病房。根据我们开展不停跳心脏直视手术体外循环的体会,我们认为,不停跳心脏直视手术方法简单,无需复杂的仪器设备,疗效确实,且又安全有效,有很高的临床推广价值。

Objective: This article reported the experience of cardiopulmonary bypass of cardiac surgery with mild hypothermia and beating heart. Methods:From Oct. 1999 to Nov. 2000,the cardiopulmonary bypass of cardiac surgery with mild hypothermia and beating heart was used in 36 patients in Shanghai Chest Hospital. They were 59±17 years old and their body surface was 1. 76±0. 24 M2. They were all male and accepted coronary artery bypass grafting. The hemotocrit was maintained between 16% -22% and the naso-pharyngeal temperature was kept between 30℃-34℃ during cardiopulmonary bypass. The aorta was not cross-clamped and the cardioplegia was not perfused. These surgeries were operated when the hearts were beating slowly (HR:60/min). Results:3. 8±0. 8 bypasses were completed in each patient. The cardiopulmonary bypass duration was 156± 42 minutes. All patients went back to ICU safely. These patients' ICU time and death rete decreased evidently than those of the contrary group patients. Conclusion: The cardiopulmonary bypass of cardiac surgery with mild hypothermia and beating heart was simple and convenient to be operated. Moreover the clinical effect was satisfied. So this technique was worth of being spreaded.