非体外循环冠状动脉搭桥术的体外循环准备策略

Strategy on preparation for cardiopulmonary bypass in off-pump coronary artery bypass grafting

目的 总结 4 6 0例非体外循环冠状动脉搭桥 (OPCAB)手术的体外循环准备情况。方法 术前计划施行OPCAB手术 4 6 0例。体外循环准备分 3种情况 :①“干备” :灌注师入手术室 ,体外循环机到位 ,不装机 ,不预充 ;②“湿备” :常规进行体外循环机准备 ,完成预充 ,动静脉插管上台 ;③“急备” :在“干备”情况下出现病情变化紧急改为“湿备”。结果 全部 4 6 0例体外循环准备中 ,“干备”32 5例 ,“湿备”1 2 7例 ,“急备”8例 ,临时转机 5例。共完成OPCAB手术 4 5 5例。术中改行体外循环的 5例中 ,由“干备”改为体外循环 1例 ,由“湿备”改为体外循环 4例 ,均在并行循环心脏跳动下完成手术。结论 体外循环准备是OPCAB手术不可缺少的一部分 ,选择体外循环准备方式时应保证“干备” ,及时“湿备” ,快速“急备”。

Objective To investigate the strategy on the preparation for cardiopulmonary bypass (CPB) during off pump coronary artery bypass grafting (OPCAB) procedure in 460 cases.Methods CABG procedure were performed in 460 cases who preoperatively expected OPCAB from October,1999 to January,2002.There were 3 types of CPB stand by situations:①dry preparation: the perfusionist, the heart lung machine and materials were standby in operating room.②wet preparation: routine preparation for CPB with tube and cannula on table.③urgent preparation: to convert dry preparation to wet preparation in some emergent conditions.Results Among the 460 cases,there were 325 dry preparations,127 wet preparations,8 urgent preparations and 5 conversions to CPB.OPCAB were performed successfully in 455 cases.The 5 cases converted to CPB included 1 from dry preparation to CPB and 4 from wet preparation to CPB.All the 3 cases were performed with beating heart in CPB.Conclusions In order to be safe, it is necessary and important to have CPB stand by during OPCAB.We should have dry preparation at all time and wet preparation in selected cases in time and be able to quickly convert dry preparation to wet preparation as need in emergent situation.It is helpful in OPCAB to make cooperation as usual between surgeons and perfusionists.