先天性心脏病常温不停跳心内直视手术(附11例分析)

Intracardiac Operations Performed in Beating Heart for Congenital Heart Diseases

目的 探讨常温体外循环心脏不停跳心内直视手术治疗先天性心脏病的方法和意义。方法 总结 11例先心病施行常温心脏不停跳心内直视手术病例 ,术中阻断上、下腔静脉 ,不阻断主动脉 ,不使用心脏停搏液 ,鼻咽部温度维持 34～ 37℃ ,均在心脏空跳的条件下完成心内直视手术。结果 全组病人术后恢复良好 ,术后血流动力学平稳 ,多巴胺用量很少 ,无栓塞、心律失常及脑部并发症。随访 3个月至 3年 ,均能参加正常活动 ,无残余分流和杂音。结论 常温心脏不停跳心内直视手术能避免心肌缺血缺氧损伤及再灌注损伤 ,使术中心肌代谢处于接近生理状态 。

Objective To evaluate the clinical experience of intracardiac operations performed in beating heart in mormothermic cardiopulmonary bypass.Method From 1999 to 2001,11 among patients received intracardiac operations under normothermic cardiopulmonary bypass with a beating heart,including 6 atrial septal defects (ASD),1 Fallot's triad (FT),1 tricuspid insufficiency(TI),1 Ebstein syndrome(ES),1 pulmonary stenosis(PS) and 1 ASD combined TI.8 were male and 3 were female.Their age ranged from 8 to 47 years.Result The cardiopulmonary bypass times ranged from 21 to 46 min.Only a few patients needed low dose of dopamine to support circulation.There were no embolism,serious arrythmia and cerebral complications.All the patients had no heart murmur and enjoyed a full range of physical activities in a follow-up of 3 to 36 months.Conclusion Continously warm blood perfusion in beating heart has good myocardial protective effect and may relieve to ischemic-reperfusion injury.