ROSS手术的体外循环管理

The Management of Cardiopulmonary Bypass during Ross Procedure

目的总结自体肺动脉瓣置换主动脉瓣,同时用同种异体肺动脉瓣行右室流出道成形术(ROSS)体外循环(CPB)特点及管理经验。方法1994年10月至2002年9月,11例主动脉瓣病变患者,全麻低温CPB下行ROSS手术,男9例、女2例,年龄8～58(33±16)岁。应用性能良好的人工心肺机、膜式氧合器。心肌保护7例应用晶体停搏液,4例应用4:1含血停搏液。复温时根据血色素应用超滤8例。2例应用洗血球机回收术中失血。结果CPB转机时间137～206(177.3±7.1)min,心肌血运阻断时间116—185(139.0±2.5)min。自动复跳率90.9％。转中超滤液400～1 800(1 112.5±478.7)ml。2例应用洗血球机共回收浓缩红细胞900ml。11例患者全部存活。结论ROSS手术应用膜式氧合器,采用浅中度低温,中度血液稀释,中等偏高流量转流是安全可靠的转流方法。转中注意心肌保护方法的综合应用;术中注意血液保护;应用超滤可灵活控制血液稀释度,减少组织水肿,有利于术后恢复。

OBJECTIVE This study was designed to summarize the experience of cardiopulmonary bypass (CPB) during Ross procedures retrospectively. METHODS Between Oct 1994 and Sep 2002, 11 patients with aortic valve diseases underwent Ross procedures. They were 9 men and 2 women. Ages ranged from 8 to 58 years (mean, 33±16 years). Membrane oxygenators were used in all cases. Crystalloid cardioplegia was adopted in 7 patients whereas 4- 1 blood cardioplegia in 4 patients. Ultrafiltration was used during rewarming phase in 8 patients according to the levels of hemoglobin. Auto-transfusion was used for blood conservation in 2 patients. RESULTS The duration time of CPB was 137 ~ 206 minutes (mean, 177.3±7.1 minutes) while cross clamp time was 116 ~ 185 minutes (mean, 139.0±2.5 minutes). The rate of spontaneous recovery of sinus rhythm was 90. 9%. In the cases using ultrafiltration, excess water was filtered from the patients body (ranging from 400 to 1800 ml, mean 1112. 5±478. 7 ml). 400 ml and 500 ml concentrated erythrocytes were retrieved with autotransfusion devices in the 2 cases. All patients survived and had uneventful recovery. CONCLUSION According to our experience, it is safe and reliable to adopt membrane oxygenator, tepid or moderate hypothermic bypass, moderate hemodilution and high blood flow perfusion strategies during Ross procedures. Myocardial protection and blood conservation should be emphasized. Ultrafiltration can be used to control hemodilution and attenuate edema in tissue, which is beneficial to the recovery of patients.