肺动脉内膜剥脱术体外循环管理经验

Management of cardiopulmonary bypass in pulmonary endarterectomy

目的总结慢性血栓栓塞性肺动脉高压(CTEPH)患者肺动脉内膜剥脱术(PEA)的体外循环管理经验。方法回顾性分析阜外医院2015年11月至2017年12月连续完成的58例因CTEPH行PEA手术患者资料,体外循环采用离心泵转流,于深低温停循环(DHCA)下完成手术操作。结果 58例患者平均转机时间(230±46)min,阻断时间(111±30)min,DHCA总时间(40±15)min,术后肺动脉压力较术前明显下降[(49±13)mm Hg vs 27(20~31)mm Hg,P<0.001],肺血管阻力也有显著改善[724(538~1 108)dyn·s/cm5vs 206(141~284)dyn·s/cm5,P<0.001]。术后院内死亡1例(1.7%)。结论体外循环是PEA围术期管理中的重要一环,关键是DHCA和器官保护。

Objective The aim of this study was to describe perfusion management of pulmonary endarterectomy（ PEA） in patients with chronic thromboembolic pulmonary hypertension（ CTEPH）. Methods Consecutive patients with CTEPH undergoing PEA between November 2015 and December 2017 at Fuwai Hospital were retrospectively analyzed. PEA was performed under deep hypothermia circulatory arrest（ DHCA） with a centrifugal pump. Results A total of 58 patients underwent PEA with CPB time of 230±46 min,aortic clamping time of 111±30 min and DHCA time of 40±15 min. Mean pulmonary artery pressure decreased（ 49±13 mm Hg vs 27（ 20-31） mm Hg,P 〈0.001） while pulmonary vascular resistance improved（ 724（ 538-1108） vs 206（ 141-284） dyn·s/cm5,P 〈0.001） significantly after the surgery. In-hospital mortality was 1.7%. Conclusion Appropriate perfusion techniques,including DHCA and organ protection,played an important role in perioperative management of PEA.