101例心脏大血管手术体外循环策略

目的探讨心脏大血管手术体外循环方法及管理经验,为心脏大血管手术顺利完成提供保障。方法我中心从2002年5月至2010年12月行各类心脏大血管手术101例,根据不同病变位置、程度和手术方式选择不同的体外循环插管和转流方法。结果体外循环转流平均时间（196.7±51.2）min,阻断主动脉平均时间（136.5±58.8）min,深低温停循环平均时间（45.3±16.9）min。术中或术毕使用人工肾进行超滤92例,滤出液体370～2 900 mL。死亡11例（10.9%）,包括低心排出量7例,呼吸循环衰竭2例,凝血障碍1例,心跳骤停1例。其余患者恢复良好,痊愈出院,无神经、精神功能障碍与体外循环相关的并发症。结论正确的体外循环转流方法和插管位置是心脏大血管手术成功的前提和保障,术中重要脏器的保护是减少并发症的关键。

Strategy of cardiopulmonary bypass for heart great vessel surgery in 101 cases

Objective To explore the methods and management experiences of cardiopulmonary bypass（CPB） for heart great vessel surgery in an aim to provide the security for the surgery.Methods Totally 101 cases of heart great vessel surgery from May 2002 to December 2010 were performed in our center.Different cannulation and perfusion methods of CPB were employed according to the different locations and severities of great vessel aneurysm as well as the different operative procedures.Results The mean time of CPB,aortic cross-clamping and deep hypothermia circulatory arrest were（196.7±51.2） minutes,（136.5±58.8） minutes and（45.3±16.9） minutes,respectively.The ultrafiltraion was used in 92 cases during or at the end of CPB and filter fluid was 370～2 900 mL.There were 11 cases died（10.9%） including 7 cases of low cardiac output syndrome,2 cases of respiratory failure,1 case of coagulating dysfunction and 1 case of heart arrest.Others recovered well,no cerebral and perfusion correlated complication was found.Conclusion The correct cannulation and perfusion methods of CPB are the preconditions and guarantee for the success of heart great vessel surgery.Protecting organs during operations is the key to the prevention of complications.