肺动脉内膜剥脱术体外循环管理

Experience in the management of cardiopulmonary bypass in pulmonary endarterectomy

目的总结评估观察肺动脉内膜剥脱术（PEA）中体外循环（CPB）管理方法的安全性。方法 10名患者均使用离心泵在深低温停循环（DHCA）下行肺动脉内膜剥脱术。体温均降至鼻咽温17~19℃,直肠温度21~24℃。心肌保护均采用康斯特保护液（HTK液）。患者术中常规超滤。结果患者肺动脉平均压和肺血管阻力较术前显著下降（P〈0.01）,均无与CPB相关的神经系统并发症,无死亡病例。CPB时间为（205.42±15.47）min,主动脉阻断时间为（120.45±10.43）min,DHCA时间为（46.91±11.32）min。患者术后常规镇静清醒时间为（30.25±9.82）h,机械通气时间为（45.38±15.57）h,ICU滞留时间为（88.59±9.75）h。结论 DHCA结合脏器保护等综合措施应用于慢性血栓栓塞性肺动脉高压的PEA术,是安全可行的CPB方法。

Objective To evaluate reliability and safety of our strategy for cardiopulmonary bypass（CPB） in pulmonary endar-terectomy.Methods Deep hypothermiccir cucirculatory arrest（DHCA） was applied for all patients by lowering the nasopharyngealtemperature to 17-19℃ and the rectal temperatureto 21-24℃. Histidine-tryptophan-ketoglutarate（HTK） solution was used for myo-cardial protection. Conventional ultrafiltration（CUF） was applied for all patients.Results No death orneurological complications re-lated to cardiopulmonary bypass happened. The mean pulmonary artery pressure（MPAP） and pulmonary vascular resistance（PVR）decreased significantly after operation. CPB time was（205.42±15.47） min with aortic cross-lamping time of 1（20.45±10.43） min,andDHCA time（46.91±11.32） min. General sedation was maintained after operation and patients resuscitated from anesthesia after（30.25±9.82） hours. The mechanical ventilation time was（45.38±15.57） hours, and ICU stay was（88.59±9.75） hours.Conclusion Theapplication of DHCA combined with organ protection during pulmonary endarterectomy procedure isa safe and feasible strategy for theCPB management.