摘要
目的 创建一种可以在术后微创拔管的新型肺动脉插管方法 ,用于右心辅助循环实验。方法 选用 7只成年犬 ,将 1个特制的可拆卸的人工血管 牛心包管“组件”(简称“组件”)的牛心包与主肺动脉吻合 ,作为肺动脉插管通道 ,组件的人工血管端及连接组件两段管道的连线经肋间小切口引到体外 ,经此途径插肺动脉灌注管到主肺动脉 ,再将组件上预置的打结 牵引线经另一肋间小切口引到体外并收紧 ;经皮切口插引流管到股静脉或颈外静脉建立右心辅助循环。停机后实施微创拔管 ,其关键步骤是依靠一种可经小切口向体内深部打结的简单方法 ,使用扩张管和打结器 ,将预置在“组件”上的滑线打结使牛心包管闭合 ,然后撤出“组件”上的牵引线、连接线和人工血管。结果 经此方法建立起的右心辅助的最大流量为 (6 4± 12 )ml·min-1·kg-1。微创拔管后活体开胸检查证实 ,除第 2例外 ,其他 6例牛心包管上的两组结 (各 8个 )均满意 ,主肺动脉吻合口和牛心包管残端均无出血。第2例第 2组的打结 牵引线被打进第 7个结中因抽不出来而部分残留。结论 该研究建立的这种可以在术后微创拔管的新型插管方法简单方便、安全有效 ,右心辅助的血流动力学效果满意 ,将来可为心外科医生在选择辅助循环时解除后顾之忧。
Objective To create a new method of pulmonary artery cannulation during operation for right ventricular assistance, for which minimally invasive decannulation can be done after operation. Methods A specially-made disassemblable composite graft consisting of a woven dacron tube and a bovine pericardial tube (composite graft) was anastomosed to the pulmonary artery as a pathway in seven dogs by median sternotomy. The end of the woven dacron tube and a link-thread for connecting the two tubes in the composite graft were drawn outside the body through an intercostal tunnel. A predisposed drawing-tieing thread in the composite graft was drawn outside through another intercostal tunnel and then tightened. An inflow cannula was placed into the left femoral vein or jugular vein via an incision of skin so as to establish a right ventricular assist system. By means of the centrifugal pump, the right ventricular bypass was established. After stopping the pumping, the 2 sets of predisposed prolene thread in the composite graft were tied by catheter and knotting tool via the small skin incision, 8 knots for each set, to close the bovine pericardial tube, and then the drawing-tieing thread, link-thread, and the dacron tube in the composite graft were removed. Median sternotomy was performed again to observe the anastomotic stoma, the closure of the stump of bovine pericardial tube, and whether hemorrhage occurred. Results The mean maximum output of right ventricular assist system from left femoral or jugular vein to pulmonary artery was (64.4±12.3) ml·min -1 ·kg -1 . The second sternotomy showed satisfactory knotting on the bovine pericardial tube except in one case,whose second set of drawing-tieing thread was tied in the seventh knot and failed to be drawn out, thus partially remained in the body. No bleeding was found in all cases. Conclusion The new cannulating methods with minimally invasive decannulation after operation created in this study is simple, easy and effective.
出处
《中华医学杂志》
CAS
CSCD
北大核心
2004年第7期596-598,共3页
National Medical Journal of China
关键词
肺动脉插管
微创外科
动物实验
辅助循环
血流动力学
Animal experiment
Pulmonary artery cannulation
Minimally invasive decannulation