心脏再次手术的体外循环管理经验探讨

Management of extracorporeal circulation in redo cardiac surgery

目的总结心脏再次手术的体外循环(ECC)管理经验,以期改善患者预后。方法回顾性分析2018年4月至2018年10月实施的心脏再次手术病历资料24例。其中,经升主动脉-上下腔静脉插管10例,股动脉-上下腔静脉插管11例,股动-静脉插管1例,升主动脉-腔房管2例。所有患者均在浅-中低温下行ECC,且均采用3~4∶1冷含血心肌保护液。结果本组心脏自动复跳20例(83%),体表除颤2例。其中,3例因停机后循环功能不稳,立即再次循环辅助10 min左右停机,其余均顺利停机。本组患者无死亡病例,其中,术后发生急性肾损伤2例;手术切口感染2例;三度房室传导阻滞1例;截瘫1例;肺部感染1例;其余均治愈出院。结论再次手术患者病史长、病情复杂,重视心肌保护,需采用综合的ECC管理措施,以改善患者预后。

Objective To summarize the experience of extracorporeal circulation(ECC)in 24 cases of redo cardiac surgery.Methods Retrospective analysis of 24 cases of redo cardiac surgery in recent half year was performed,including 10 cases intubated via the ascending aorta and the inferior and superior vena cavae,11 cases intubated via the femoral artery and the inferior and superior vena cava,1 case intubated via the femoral artery and femoral vein,and the other 1 case intubated via the ascending arota and the right atrium.All operations were performed in mild and moderate hypothermia with(3-4):1 cold oxygenated blood myocardial protection solution.Results The heart rebeated automatically in 20 cases,and 2 cases were defibrillated.Three cases had circulatory unstability after ECC and recovered after 10 minutes of extra circulation assistance.Two patients suffered from acute kidney injury,and 2 patients suffered from incision infection.Three-degree atrioventricular block occured in 1 patient,paraplegia occured in 1 patient and pulmonary infection occured in 1 patient.No hospital death happened among those patients.Conclusion Taking comprehensive measures to enhance myocardial preservation and cardiopulmonary bypass management is important for patients undergoing secondary surgery because of their long history of disease,poor cardiac function and prolonged ECC time.