全胸腔镜心脏手术体外循环插管的选择

目的总结电视胸腔镜心脏手术体外循环动静脉插管的选择方法及对体外循环灌注过程的影响。方法 205例心脏病手术患者,其中男性87例,女性118例;年龄3～46岁,平均年龄16.2岁;体质量13～84kg,平均体质量38.2kg。对其采用胸腔镜建立体外循环,分析股动脉、股静脉及上腔静脉插管型号与患者体质量关系及插管型号对体外循环灌注过程中灌注流量及动脉灌注管阻力的影响。结果 114患者例采用股动脉、股静脉插管,91例采用股动脉、股静脉/腔静脉插管建立体外循环。205例患者中有15例在高于2.2L/min流量灌注过程中动脉灌注管阻力高于40kPa（300mmHg）,其他患者灌注流量与动脉灌注管阻力均能达到临床要求。结论全胸腔镜体外循环下实施心脏手术选择合适的股动静脉插管可以保证体外循环灌注的有效性与安全性。

Choice of cannulation for completely video-assisted thoracoscopic surgery with cardiopulmonary bypass

Objective To summarize method and effect of arteriovenous cannulation during cardiopulmonary bypass（CPB） for completely video-assisted thoracoscopic surgery.Methods A total of 205 heart surgery patients was enrolled, male 87, female 118, aged 3-46 years, mean age 16.2 years;body weight 13-84 kg, mean body weight 38.2 kg.The CPB were performed with thoracoscope, the relationship between femoral artery, femoral vein and vena cava superior pattern with body weight, the effect of cannulation pattern with perfusion flow and arterial perfusion tube resistance were analyzed.Results The 114 cases were performed CPB through femoral artery and femoral vein, 91 cases were performed CPB through femoral artery and femoral vein and vena cava superior, 15 cases of arterial perfusion tube resistance surpass 40 kPa（300 mmHg） when perfusion flow more than 2.2 L/min and the others perfusion flow rate and arterial perfusion tube resistance achieved clinical requirement.Conclusion It is demonstrate that the suitable cannulation of femoral artery and femoral vein could ensure the effectively and security of CPB during completely videoassisted thoracoscopic surgery.