胸腹主动脉置换术中股静脉-股动脉转流的体外循环管理

Cardiopulmonary bypass management of femoral vein and artery diversion during thoracoabdominal aortic replacement

目的目前胸腹主动脉置换术(TAAR)中股静脉-股动脉转流的体外循环管理相关报道较少。文中旨在探讨采用股静脉-股动脉转流下TAAR术中的体外循环管理效果。方法回顾性分析2017年1月至2021年4月东部战区总医院心胸外科9例接受TAAR体外循环管理患者的临床资料。TAAR术中采用股静脉-股动脉插管部分体外循环转流联合腹腔器官持续灌注的体外循环管理。统计分析主要评价指标肾、脊髓术后损伤情况,以及肠系膜、腹腔干缺血情况。结果术后患者均无截瘫、肠缺血。2例患者术后出现脊髓可逆性缺血性损伤,经治疗后改善;1例术后出现急性肾功能衰竭,经治疗肾功能恢复;1例患者术后出现消化道出血,经治疗症状改善;其余患者恢复良好,所有患者均痊愈出院。结论胸腹主动脉置换术中采用股静脉-股动脉插管部分体外循环转流联合腹腔器官持续灌注的体外循环管理,技术安全可行,腹腔器官保护效果较好。

Objective Rare report has been found on the cardiopulmonary bypass management of femoral vein and artery diversion during thoracoabdominal aortic replacement(TAAR).This study sought to explore the effects of cardiopulmonary bypass management in TAAR with femoral vein and artery diversion.Methods A total of 9 patients undergoing cardiopulmonary bypass management during TAAR in the Department of Cardiothoracic Surgery,General Hospital of Eastern Theater Command from January 2017 to April 2021,was included in this retrospective study.During TAAR,the combination of extracorporeal circulation with femoral arteriovenous intubation and cardiopulmonary bypass management of abdominal organ continuous perfusion was used.The status of postoperative injury of kidney and spinal cord,and mesentery and celiac trunk ischemia were evaluated and analyzed.Results No patient had paraplegia and intestinal ischemia.Two patients suffered reversible spinal cord ischemic injury after operation and recovered after treatment.One patient developed acute renal failure postoperatively and his/her renal function recovered after treatment.Postoperative gastrointestinal bleeding occurred in 1 patient,whose symptoms improved after treatment.The remaining patients were in good condition.All patients were recovered well and discharged.Conclusion The combination of extracorporeal circulation with femoral arteriovenous intubation and cardiopulmonary bypass management of abdominal organ continuous perfusion during TAAR is reliable and has good effect.