老年心脏手术体外循环探讨

The experience of cardiopulmonary bypass in senile patients

目的 :探讨老年心脏手术体外循环技术。方法 :分析 4 9例 6 0岁以上患者体重 ,体外循环中血液稀释度 ,预充液晶胶比。监测术中血气、血钾、血流动力学改变、温度及转流时间。结果 :体外循环时间 32～ 4 2 0min ,主动脉阻断时间 2 0～ 2 5 1min ,其中 >12 0min 13例。术中灌注压 6 0～ 80mmHg(1mmHg=0 .133kPa) ,血钾 5 .0～ 5 .3mmol L ,血气 (37℃ )pH 7.4～ 7.5 ,PCO2 3.7～ 5 .2kPa ,HCO32 2 .0～ 2 6 .8,心脏自动复跳率 5 5 .1%。全组 4 9例中 ,术后死亡 2例。结论 :为了提高老年心脏手术体外循环质量及手术成功率 ,强调①选择优质膜式氧合器。②体外循环中维持红细胞压积稍高于青、中年人。③采用高流量灌注 ,维持良好灌注压。④含血停搏液行心肌保护。

Objective: To investigate the clinical measures of cardiopulmonary bypass(CPB) in senile patients.Methods:A retrospective analysis was made in 49 cases aged over sixty. Patient's weight, the level of hemodilution, the ratio of priming colloid and crystalloid, the changes of hemodynamic and so on were measured during operation.Results: The duration of CPB ranged from 32 to 420 minutes. The aortas were cross clamped for 20～281 minutes and among them, in 13 cases,the aorta was clamped for 120 minutes. During operation, the perfausion pressure was 60～80 mmHg. The concentration of blood potassium was 5.0 ～ 5.3 mmol/L, blood (37℃) pH 7.4 ～ 7.5 . PCO 2 3.7 ～ 5.2 kPa, and HCO 3 22.0 ～ 26.8 . After operation, the heart beat reverted spontaneously in 55.1 % of fotal patients and only 2 cases died.Conclusion: For elevating the success of CPB during operation in senile patients, the following measures are emphasijed: ①Use of membrane oxygenators with high quality. ②HCT level of senile patients should be a little higher than that of young and middle aged. ③Elevate mean arterial pressnre to keep high perfusing flow. ④Use blood cardioplegia of 4∶1 for protecting the myocardium. ⑤Use of aprotininum and IABP.