完全胸腔镜下心脏手术体外循环管理

Cardiopulmonary bypass management under totally videoassisted thoracoscopic cardiac surgery

目的总结完全胸腔镜下心脏外科手术的体外循环管理方法。方法完全胸腔镜下心脏外科手术110例,其中,房间隔缺损修补术79例（合并三尖瓣关闭不全25例）,室间隔缺损修补术16例,部分型心内膜垫缺损矫治术4例,二尖瓣置换10例,三房心矫治1例,并对体外循环建立方法、体外循环过程及手术后结果进行评价。结果 110例患者体外循环转流时间为61~364（133±64）min;升主动脉阻断时间为17~192（82.0±44.5）min;术后呼吸辅助时间4.0~26.5（4.5±1.8）h;术后住院时间5~10 d;92例患者围术期未使用血制品（83.6%）。术中1例患者股动静脉插管时未完全肝素化,更换股动静脉插管后顺利体外循环;1例患者插股静脉管导致腹膜后血肿,其余108例无股动静脉插管相关并发症,全组患者术后均恢复良好,无严重并发症。结论完全胸腔镜下心脏手术体外循环方法安全、可行,开展此手术的初期体外循环时间和主动脉阻闭时间相对较长,应加强体外循环的管理。

[ Objectives ] To summarize the management of cardiopulmonary bypass （CPB） with totally video-assisted thoracoscopy in heart operation. [Methods] The CPB established methods, CPB process and postoperative results of 110 patients undergoing operation with totally video-assisted thoracoscopy were analyzed. The surgical procedures included 79 cases of atria septal defect repair （25 concomitant tricuspid valve plasty）, 16 vcntricular septal defect repair, 4 partia atrioventricular canal defect repair, lO mitral valve replacement and 1 triatriatum defect repair. [ Results ] 110 cases CPB time was 61-364 （133±64）min, the aortic cross-clamping time was 17~192 （82±45）min, post-operation respiratory auxiliary time was 4.0-26.5 （4.5±1.8）h, post-operation hospitalization duration was 5-10 days, and 92 cases did not use blood products （83.6%）. One patient was not fully heparinization during CPB intubatiou, and replaced the femoral artery and venous intubation before CPB. Retroperitoneal oma was caused in one patient by CPB intubation. All patients recovered well and discharged uneventfully. [ Conclusion] Heart operations can be done by applying cardiopulmouary bypass with totally video-assisted thoracoscopy. The method is safe and practicable. But it should be modified to shorten the duration of CPB and aorta clamping.