心脏肿瘤手术的体外循环管理(附117例报告)

The management of cardiopulmonary bypass during the operation for heart tumor (report of 117 cases)

目的 回顾心脏肿瘤手术的体外循环管理 ,为不典型心脏手术体外循环提供参考依据。方法 自 1996年 10月至 2 0 0 1年 4月实施心脏肿瘤手术 117例 ,体外循环心脏直视下完成 111例 ,3例心包囊肿 ,3例因肿瘤弥漫性浸润无法切除行姑息性手术。体外循环以浅低温高流量体外循环为主 ,配合深低温低流量或深低温停循环。结果 2 2例发生肝素耐药现象 ,首次全量肝素化后ACT为 (32 6± 35 )s ,首次追加肝素量为 2 0 0U kg ,术中肝素总量平均 76 3U kg;除姑息手术外 ,均未出现围术期并发症 ,痊愈出院。良性肿瘤随访 6个月至 3年无复发。结论 心脏肿瘤体外循环下手术治疗 ,需根据准确的术前定位 ,选择适当的体外循环方法 ,做好体外循环准备 ;术中ACT监测及血流动力学稳定是体外循环综合管理的关键。

Objective: To review the experience of management of cardiopulmonary bypass (CPB) during the operation for heart tumor. Methods: There were 117 heart tumor patients undergoing surgery since Oct. 1996 to Apr. 2000 in our institute. Among them, 111 patients were operated under CPB (primary carcinoma in 108, the secondary tumor in 3). 3 patients with pericardiac cyst were operated without CPB. Three patients were chosen for palliative procedure without CPB because of the extension of the tumor. Mild hypothermia and high flow CPB technique was used in majority of procedures and deep hypothermia and low flow or deep hypothermic circulatory arrest CPB technique was utilized only under some special situations. During CPB, the SvO 2 and ACT were monitored. Water, electrolyte and acid aldali balance were maintained in normal range. Results: There was no operative death and complication. The mean CPB time was (68 49±18 76) minutes. The mean ICU stay was 56 hours. Heparin resistance was found in 22 patients during CPB. Conclusion: The surgical treatment of heart tumor with CPB is safe and effective. The position of the tumor must be confirmed before the operation. Selectively using different methods of CPB is the key for success.