急诊体外循环在心血管手术中的应用

CLINICAL APPLICATION OF EMERGENCY EXTRACORPOREAL CIRCULATION

目的 总结应用急诊体外循环抢救和治疗重危心血管病患者的经验。方法 2 9例重危患者均在全麻体外循环下行紧急心血管手术 ,其中 5例采用常温左心辅助转流 ,其余采用中低温中、高流量灌注 ;上下腔静脉 主动脉转流 16例 ,上下腔静脉 股动脉转流 7例 ,左心房 股动脉转流 4例 ,股动脉 股静脉转流 2例。术中采用温血顺、逆灌等多种心肌保护方法。结果 全组快速建立体外循环的时间为 10～ 15min ,总体外循环时间 78～ 186min ,主动脉开放后自动复跳率 86%。手术早期死亡 3例 ,死亡率 10 3 4 % ,余 2 6例痊愈出院。结论 对心衰难以控制 ,全身重要脏器面临不可逆损害的患者ECC的使用应采取积极态度 ,尽早通过体外循环纠正原发病变 ,快速建立体外循环以股动、静脉插管为首选 ,体外循环管理强调“快”

Objectives: To evaluate the clinical application of emergen cy extracorporeal cirulation(ECC) in cardiac surgery. Methods: E mergency open heart surgery was performed in 29 ECC cases. Warm blood left heart bypass was performed in 5, hypothermic cardiopulmonary bypass in 24. The vena c ava-aorta extracorporeal criculation was built in 16,vena cava-femoral in 7, l eft atrium-femoral in 4 and femoro-femoral in 2. Almost of them were combined with retrograde perfusion through or antegrade through aortic root to portect t he heart. Results: The carddiopulmonary bypass was established quickly in 10 to 15 minutes with an average duration of cardiopulmonary bypass of 78～186 min. There were 2 hospital deaths, the hospital mortality rate was 10 34%. The rest 26 patients were discharged from the hospital. Conclusi ons: emergency cardiopulmonary bypass support is a powerful resuscitati ve tool that may stabilize the conditi