体外循环心内直视手术的术后出血及心包填塞的外科治疗

The management of postoperative bleeding or cardiac temponade after open-heart surgery under cardiopulmonary bypass

目的 探讨体外循环 (CPB)心内直视术后出血和心包填塞的发生原因及其诊断、治疗和预防。方法 复习本院心外科 17年内 985 8例CPB心内直视手术中 187例因术后出血或心包填塞而再次行剖胸手术患者的临床资料 ,总结患者术后出血的程度及再次行剖胸手术的时间 ,探讨术后心包填塞的临床表现及外科治疗特点。结果 再次剖胸手术中出血 4 4例 ,术后急性心包填塞 12 6例、延迟心包填塞 17例 ,死亡 18例 ,再次剖胸手术的死亡率为 9.9%。再次手术者所患疾病包括先天性心脏病 12 0例 ,瓣膜疾病 6 4例 ,冠心病 2例。结论 减少CPB后出血、渗血是避免术后发生出血或心包填塞的关键 ,早期诊断并采取果断措施尽早行再次剖胸手术可明显降低围术期死亡率。

Objective To analyse the cause, diagnosis and treatment of postoperative bleeding, with special emphasis on cardiac tamponade after CPB. Methods We reviewed 9 858 consecutive patients with open heart surgery under CPB from 1985 to 2002. Among them, there were 187 patients of reoperation due to postoperative bleeding including cardiac tamponade. They were divided into two categories: one group with bleeding and the other group with cardiac tamponade. Results Of the entire series, 44 patients had bleeding, 126 patients had acute cardiac tamponade, 17 patients had late cardiac tamponade. Eighteen patients died after reoperation. Severe complications included acute renal failure and cardiac arrest. Conclusion Early surgical treatment should be awared and taked promptly. It is mandatory to release mechanical pressure on the heart to avoid acute renal failure or cardiac arrest. All there patients should be reoperated upon as early as possible if satisfactory results are to be expected.