大心室瓣膜置换患者体外循环管理

Management of Cardiopulmonary Bypass during Heart Valve Replacement of Patients with Large Ventricle

目的 回顾 61例左室舒张末径大于 6.5cm的行瓣膜置换术患者 ,总结体外循环 (CPB)经验。方法 CPB采用中度低温 ,3例二次开胸不能分离上下腔行停循环 (鼻咽温 18～ 2 2℃ )。合并三尖瓣关闭不全 ,巨大右房 ,腹水 ,恶液质的患者 ,预充白蛋白并附加人工肾超滤 ,心肌保护为高钾含血停搏液灌注。结果 CPB时间 41～ 2 15min ,深低温停循环(DHCA)时间 45～ 66min,心肌缺血时间 2 8～ 178min。心脏自动复苏率 92 %。无全心辅助及左心辅助。围术期死亡 4人。结论 手术中有效的心肌保护 ,提高胶体渗透压 ,可减低手术后心功能衰竭 ,降低并发症和死亡率 ,是患者平稳度过围手术期 。

OBJECTIVE 61 patients with left ventricular's diameter all over 6.5 cm for valve replacement undergoing cardiopulmonary bypass(CPB) were reported. METHODS Mild hypothermic CPB were used in 58 cases. Deep hypothermic circulatory arrest(DHCA) CPB were used in 3 patients, whose superior vena cava and infusion vena cava were used in patient with tricuspid valve is insufficiency, large atrium dextrum, ascase, heart cachexia, and potossium infusion blood crystalloid cardioplegia for protection were used in all patient. RESULTS CPB time range from 41 to 215 min, deep hypothermic circulatory arrest(DHCA) 45～66min and the aortic clamped time 28～173min. Resuscitation of heart was 92%. None of the patients need left ventricular support. 4 patients died in perioperation.CONCLUSION Effective myocardial protection and raise of blood crystalloid pressure reduce postoperative heart failure, motality of complication, morbidity, and help patients smoothly pass perioperation raise up survial rate.