全胸腔镜心脏瓣膜手术体外循环管理体会

Management of extracorporeal circulation during totally thoracoscopic cardiac valvular operation

目的总结全胸腔镜心脏瓣膜手术体外循环(extracorporeal circulation,ECC)管理经验。方法自2016年4月至2016年9月在广东省人民医院行全胸腔镜心脏瓣膜手术119例,全部经颈内静脉和股动、静脉置管行ECC,应用负压辅助静脉引流(VAVD)技术。ECC中鼻咽温28℃~31℃,灌注流量60~80 m L/(kg.min),经加长型灌注针向主动脉根部灌注冷4∶1含血心肌保护液保护心肌。结果 119例患者ECC时间为(143.4±33.9)min,升主动脉阻断时间为(92.4±21.3)min,所有患者手术过程顺利。结论在全胸腔镜心脏瓣膜手术中辅用负压辅助静脉引流技术能明显改善单靠重力静脉引流的不足,选择相对偏大的股动脉插管管径有利术中管理,注意主动脉阻断前的温度管理。

Objectives To summarize the experiences of extracorporeal circulation（ECC）management during totally thoracoscopic cardiac valvular operation. Methods From April 2016 to September 2016,119 patients（50 males and 61 females） underwent totally thoracoscopic cardiac valvular operation in Guangdong General Hospital were selected. ECC was set up through femoral arterial and venous cannulation and percutaneous superior vena cava cannulation. Vacu-um assisted venous drainage（VAVD）technology was used during ECC. The flow of ECC was about 60-80 mL/（ kg · min） under moderate hypothermia（ 28℃-31℃）. Myocardium was protected by perfusion with 4：1 cold oxygenated blood via the arotic root. Results Of the 119 patients,ECC duration was（143.4±33.9）min and average aortic clamp-ing duration was（ 92.4±21.3）min. All the patients were successfully operated. Conclusions ECC during the totally thoracoscopic cardiac valvular operation assisted by VAVD technology can significantly improve the shortage of gravity venous drainage. Selecting relatively large size of the femoral artery cannulation is beneficial to the management of the ECC. Attention should be pay to the management of temperature before aortic clamping.