左心转流结合回收式自体血输入在降主动脉置换术体外循环支持中效果观察

Application of left heart bypass combined with autologous blood transfusion in cardiopulmonary bypass in descending aorta replacement

目的 探讨降主动脉置换术中采用左心转流结合回收式自体血输入体外循环支持的临床效果及意义。方法 行降主动脉置换术患者36例,其中术中采用股动脉、静脉插管常规体外循环支持者20例为对照组,术中采用左心转流结合回收式自体血输入体外循环支持者16例为观察组。比较2组体外循环时间、降主动脉阻断时间、术后第1天引流量、气管插管时间、ICU住院时间及降主动脉阻断时、开放时桡动脉、股动脉平均压,观察术后1周监护室恢复期间苏醒延迟、低氧血症、急性肾功能衰竭等并发症发生情况。结果 观察组体外循环时间[(75.0±12.0)min]、降主动脉阻断时间[(62.0±13.0)min]、气管插管时间[(24.1±6.9)h]、ICU住院时间[(2.6±1.2)d]均短于对照组[(107.0±13.0)min、(89.0±10.0)min、(44.6±7.7)h、(4.1±2.7)d](P<0.05),术后第1天引流量[(270.0±68.8)mL]少于对照组[(350.0±50.7)mL](t=13.765,P<0.001)。观察组降主动脉阻断时、开放时股动脉平均压[(57.2±5.6)、(64.5±4.8)mm Hg]均高于对照组[(32.5±4.6)、(52.5±4.6)mm Hg](t=14.538,P<0.001;t=7.630,P<0.001),桡动脉平均压与对照组比较差异无统计学意义(P>0.05)。对照组术后发生苏醒延迟3例,低氧血症3例,急性肾功能衰竭2例,偏瘫1例,截瘫3例;观察组术后发生苏醒延迟1例,低氧血症1例,急性肾功能衰竭1例,无偏瘫、截瘫发生;对照组术后并发症发生率(60.0%)高于观察组(18.8%)(χ^(2)=6.223,P=0.013)。结论 左心转流结合回收式自体血输入体外循环可维持降主动脉置换术中循环稳定,缩短体外循环时间,降低术后并发症发生率。

Objective To investigate the clinical efficacy and significance of cardiopulmonary bypass(CPB) with left heart bypass combined with recycled autologous blood transfusion in descending aorta replacement. Methods Thirty-six patients underwent descending aorta replacement, in which 20 patients received femoral artery and venous catheterization in CPB(control group), and 16 patients received CPB with left heart bypass combined with recycled autologousblood transfusion(observation group). The CPB time, descending aorta occlusion time, drainage volume on the first day after operation,tracheal intubation time,length of ICU stay,mean femoral artery pressure at descending aorta occlusion and opening,and incidences of delayed awakening,hypoxemia and acute renal failure in the first week in ICU were compared between two groups.Results In observation group,the CPB time,descending aorta occlusion time,tracheal intubation time and length of ICU stay were shorter in observation group[(75.0±12.0)min,(62.0±13.0)min],(24.1±6.9)h,(2.6±1.2)d]than those in control group[(107.0±13.0)min,(89.0±10.0)min,(44.6±7.7)h,(4.1±2.7)d](P<0.05).On the first day after operation,the drainage volume was less in observation group [(270.0±68.8)mL]than that in control group [(350.0±50.7)mL](t=13.765,P<0.001).The femoral artery blood pressures at descending aorta occlusion and opening were higher in observation group [(57.2±5.6),(64.5±4.8)mm Hg]than those in control group[(32.5±4.6),(52.5±4.6)mm Hg](t=14.538,P<0.001;t=7.630,P<0.001).There were3cases of delayed awakening,3cases of hypoxemia,2cases of acute renal failure,1case of hemiplegia and 3cases of paraplegia in control group,and 1case of delayed recovery,1case of hypoxemia,1case of acute renal failure,no hemiplegia and no paraplegia in observation group.The incidence of postoperative complications was higher in control group(60.0%)than that in observation group(18.8%)(χ^(2)=6.223,P=0.013).Conclusion CPB with left heart bypass combined with recycled autologous blood transfusion can maintain the circulatory stability in descending aorta replacement,shorten the CPB time,and reduce the incidence of complications.