机器人辅助下二尖瓣成形或置换术的体外循环管理

Management of extracorporeal circulation for totally robotic assisted underwent mitral valve plasty or mitral valve replacement

目的探讨本院机器人（Da Vinci）辅助下二尖瓣成形或置换术的体外循环管理经验。方法 2014年12月至2015年6月在机器人辅助下完成二尖瓣成形或置换术10例,其中二尖瓣置换术5例,二尖瓣成形术5例,所有病例均采用股动脉、股静脉插管建立体外循环,术中放置食道超声（TEE）,均采用离心泵作为主泵灌注,术中心肌保护均为晶体St.Thomas液（钾离子浓度20 mmol/L）加康斯特（HTK）液,术中采用负压辅助静脉引流（VAVD）,连续混合静脉氧饱和度监测以及常规超滤。结果 10例患者转流时间为171~249（192.7±18.7）min,升主动脉阻断时间为95~165（115.9±21.5）min,开放升主动脉后均自动复跳,术中无1例血红蛋白尿出现。8例患者术后24 h内拔出气管插管,2例由于引流偏多于术后48 h内拔出气管插管,10例患者无1例死亡,均顺利出院。结论机器人辅助下二尖瓣成形或置换术经股动脉、股静脉建立体外循环,术中采用St.Thomas＋HTK液心肌保护,VAVD辅助引流,监测静脉氧饱和度（SvO2）及常规超滤,效果良好。

Objective To discuss the management of extracorporeal circulation for totally robotic assisted mitral valve repairorreplacement.Methods MethodsFrom December2014 to June 2015,10 patients underwent mitral valve repairor replacement, including5 cases of MVR and 5 patients MV repair.The setting up of ECC was achieved with femoral artery cannulation and femoral venous can-nulation under the guidance of transesophageal echocardiography. All the patients were perfused bycentrifugal pump. Myocardial protec-tion was managed with St.Thomas solution plusHTK solution. For all cases, VAVD, SvO2 mornitoring and conventional ultrafiltrationwere routinely performed.Results The ECC time was 171~249（192.7±18.7） min and aortic clamp time was 95~165（115.9±21.5）min. All cases were resuscitated automatically and no hemoglobinuriaoccurred. Eight patients hadpostoperative intubation time less than24 h in,and 2 cases had prolonged intubation up to 48 hdue to excessive chest drainage. No death orother complication occurred in 10 ca-ses.Conclusion The establishment of ECC system through femoral artery and femoral venous cannulation is reliable for totally roboticassisted mitral valve repairor replacement. Myocardial protection was managed with St. Thomas and HTK solution. VAVD,SvO2 andconventional ultrafiltration are extremely necessary and the result is reliable.