浅低温心脏跳动下房、室间隔缺损修补术56例临床分析

SURGICAL TREATMENT OF VENTRICULAR AND ATRIAL SEPTAL DEFECTS IN BEATING HEART AND MILD HYPOTHERMIA

目的 探讨浅低温体外循环心脏跳动下房、室间隔缺损修补术的应用前景。方法 应用浅低温心脏跳动下心内直视手术方法,对先天性心脏病房间隔缺损15例及室间隔缺损(室缺)41例患者施行房、室间隔缺损修补术。结果 全部患者手术过程顺利,术中未出现心室颤动,术后胸腔引流量少,未发生严重心律失常、低心排血量综合征、空气栓塞等并发症。结论 本方法避免了主动脉阻断所引起的心肌缺血、缺氧和再灌注损伤以及心脏局部冰屑及冷停跳液所致的物理性损伤,是一种较接近生理状态的心肌保护法,能较好地保护心肌功能,手术操作简单,能清楚地发现隐匿及多发性室缺,降低残余漏;避免传导系统的损伤;在做好排气措施下,是一种安全可行的方法。

Objective To evaluate the applicable prospects of treatment for atrial septal defects(ASD) and ventricular septal defects(VSD) in beating heart and mild hypothermia. Methods 15 patients with atrial septal defects and 41 patients with ventricular septal defects, received open heart surgery under cadiopulmonary bypass(CPB) in beating heart and mild hypothermia. Results The operating procedure in all patients performed suce sfully, there were no ventricle trembling occurred during the operation, none occured the complications such as serious arrhythmias, low output syndrome and gas embolism. Conclusion The open heart surgery in beating heart and mild hypothermia has protective effects on myocardium, which maybe attributed to the reduction of ischemia-reperfusion injury. It can also find the hidden ventricular septal defects, which reduce the residual shunt rate and prevent the trauma in conduct system. This approach is proved to be safe and effective.