全胸腔镜主动脉瓣置换术的体外循环管理

Cardiopulmonary Bypass Management in Total Thoracoscopic Aortic Valve Replacement

目的总结全胸腔镜主动脉瓣置换术的体外循环管理体会。方法将2020年1月至2023年4月在南方医科大学附属广东省人民医院接受主动脉瓣置换的22例主动脉瓣狭窄患者作为研究对象。所有患者的右侧胸壁打3孔,作为手术操作入路,采取股动静脉插管,辅以负压静脉引流技术。体外循环中采取中低温28℃至31℃鼻咽温、中低流量50~70 mL·kg^(-1)·min^(-1)。统计患者的手术完成情况、体外循环时间、主动脉阻断时间、术中最低温度、心脏复搏方式、术后呼吸机辅助呼吸时间、重症监护室住院时间、24 h的胸腔引流量、术后2 h、4 h、8 h、12 h、24 h乳酸浓度、术后24 h尿量、死亡情况。结果22例患者手术均成功,体外循环时间为(179.00±56.50)min,主动脉阻断时间为(116.0±30.7)min,术中最低温度为(30.50±0.79)℃,心脏复搏方式中自动复搏患者占81.8%,电击复搏患者占18.2%,术后呼吸机辅助呼吸时间为(17.9±16.4)h,重症监护室住院时间为(54.7±25.4)h,24 h的胸腔引流量为(230±116)mL,术后24 h尿量为(3138±748)mL。无患者出现心肺并发症和死亡情况。结论经股动静脉插管建立外周体外循环能够有效配合全胸腔镜主动脉瓣置换术。

Objectives To summarize the experience of cardiopulmonary bypass(CPB)management in total thoraco⁃scopic aortic valve replacement(AVR).Methods A total of 22 patients with aortic valve stenosis who underwent AVR in Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University from January 2020 to April 2023 were included.All the patients underwent surgery via a three-port approach on the right thoracic wall,using femoral artery and vein cannulation,supplemented by vacuum-assisted venous drainage.During cardiopulmonary bypass(CPB),a moderate hypothermia of 28℃to 31℃nasopharyngeal temperature and a moderate flow rate of 50-70 mL·kg^(-1)·min^(-1) were maintained.The following parameters were recorded:surgical completion status,CPB duration,aortic cross-clamp duration,intraoperative lowest temperature,method of cardiac resuscitation,duration of postoperative mechanical ventilation,duration in the intensive care unit(ICU),24-hour chest drainage volume,lactate values at 2 h,4 h,8 h,12 h,and 24 h postoperatively,24-hour postoperative urine output,and mortality.Results All the 22 patients successfully completed the surgery.The CPB duration was(179.00±56.5)minutes,aortic cross-clamp duration was(116.0±30.7)minutes,and the intraoperative lowest temperature was(30.5±0.79)℃.Automatic cardiac resuscitation occurred in 81.8%of the patients,while 18.2%required electrical defibrillation.The duration of postoperative mechanical ventilation was(17.9±16.4)h,ICU duration was(54.7±25.4)h,and 24-hour chest drainage volume was(230±116)mL.The 24-hour postoperative urine output was(3138±748)mL.There were no cases of cardiopulmonary complications or mortality.Conclusions Peripheral CPB established via femoral artery and vein cannulation can effec⁃tively support total thoracoscopic AVR.