电视胸腔镜心脏手术微创体外循环中并发症的预防及处理方法

The methods of prevention and processing for complication on cardiac surgery with thoracoscopy during cardiopulmonary bypass

目的 :探讨电视胸腔镜微创体外循环心内直视术治疗先天性心脏病手术过程中并发症的预防及处理方法。方法 :2 0例房间隔缺损和 4例室间隔缺损的先心病患者应用双腔气管插管机械辅助呼吸 ,采用股动脉、股静脉和上腔静脉插管建立体外循环 ,通过胸壁打孔借助电视胸腔镜进行房间隔缺损和室间隔缺损修补。结果 :2 4例患者中第 1例患者因血氧饱和度低而延长切口进行探查 ,1例患者因主动脉壁损伤而被迫再次建立体外循环进行修补 ,2例患者体外循环转流中出现血红蛋白尿 ,3例患者在单肺通气时因血氧饱和度低而应用高频通气进行辅助 ,1例室间隔隔瓣下缺损患者心脏复跳后发现有残余漏。结论 :电视胸腔镜微创体外循环下心内直视术中以单肺通气时血氧饱和度低、转流中血红蛋白尿最为常见 ;以操作不慎引起大血管损伤最为严重。创伤小 ,恢复快 ,安全可行。只要熟练电视胸腔镜下手术器械的操作方法和技巧可以减少或避免并发症的发生。

Objective:To summarize and to analysie the complication and the reason of congenital heart disease surgery with video assisted thoracic during micro-cardiopulmonary bypass(CPB).Methods:The arterial catheter and one venous catheter were placed in the right femoral artery and femoral vein,the other venous catheter was placed in the superior vena cava to set up CPB.Twenty atrial septal defect cases and four ventricular septal defect cases were repaired the septal defect with thoracoscopy by opening holes in chest the mechanical assisted respiration with double-tune endotracheal intubation were used for all patients.Results:One patient was extend the small professional jargon to stanch bleeding so as to avoid accidents after stopping CPB,because the oxygen saturation was low.The other patient was extending the small professional jargon to set up CPB again,because the aorta wall was injury;two patients have hemoglobinuria during CPB.There were three patients using high frequency ventilation (HFV) to help during single lung ventilate,because the oxygen saturation was low.Conclusion:The open-heart operation with VATO technique underwent micro-operation CPB.Which remarkably alleviated the wounds,make the patient recover rapidly and well,reduce the complication disease.It was safety and dependable with thoracoscopy to repair atrial septal defect underwent micro-operation CPB.It was completely to reduce the complication when we skilled the methods of instrument for thoracoscopy.