心脏跳动中房间隔缺损直视修补术的探讨

Re-discuss of Atrial Septal Defect Closure of Open Heart Surgeryin Beating Heart

目的 :进一步探讨心脏跳动中房间隔缺损直视修补术的优点、意义 ,从而确定正确的手术适应证。方法 :随机入选单纯Ⅱ孔型房缺治疗组 1 1例即在体外循环心脏跳动中完成房间隔缺损直视修补术 ,对照组 9例即在低温或中度低温体外循环心脏停跳下完成手术。结果 :术前心功能治疗组Ⅲ级 3例 ,Ⅱ级 8例 ,对照组术前心功能Ⅲ级 5例 ,Ⅱ级 4例 ,心肌酶谱治疗组和对照组术前正常或无明显变化。治疗组术后无变化或轻度改变。对照组心肌酶谱各项指标均有不同程度升高。两组痊愈出院。随访 3～ 4 8个月 ,效果满意。心功能治疗组Ⅰ级 1 1例 ,对照组Ⅱ级 1例 ,Ⅰ级 8例。结论 :心脏跳动中房间隔缺损直视修补术符合当前微创心外科的基本原则。

Objective:To evaluate the advantage and significance of atrial septal defect closure of open heart surgery in beating heart thereby confirming operate indication.Methods:By random selection,the 11 patients of atrial septal defect closure received open heart surgery with beating heart(trial group),and 9 patients of atrial septal defect closure received open heart surgery with hypothermic or mid-hypothermic extracorporeal circulation(control group).Results:All of the 20 cases were healed.At preoperation,in trial group,3 cases of cardiac function grade Ⅲ;8 cases of cardiac function grade Ⅱ.In control group,5 cases of cardiac function grade Ⅲ;4 cases of cardiac function grade Ⅱ.Cardiac enzymes are normal in two group.At postoperation,Cardiac-enzymes of the cases of the trial group didn't raise.however all cases of the control group raises significantly.Followed-up 3-48 months,in trial group,11 cases of cardiac-function grade Ⅰ;in control group,1 cases of cardiac-function grade Ⅱ;8 cases of cardiac-function grade Ⅰ.Conclusions:Open heart surgery in beating heart of atrial septal defect closure accord with principle of the microtrauma surgery,operate indication should be received in case with simply Ⅱ hole atrial septal defect without deform of the cardiac construction and cardiac malformation else,to insure reliability of the operation