心脏跳动下心内直视手术的体外循环管理

目的探讨心脏跳动下心内直视手术中体外循环的管理方法。方法总结分析2 290例心脏跳动下行心内直视手术的体外循环管理方法。术中均常规建立左心引流,术毕采用综合序贯排气技术。转流中鼻咽温维持在30～32℃,红细胞压积维持在20%～30%,流量控制在2.4～3.2 L.m-1.min-2,采用α稳态血气管理方法,术中酌情行常规超滤或改良超滤。结果全组体外循环均顺利停机,转流时间22～179 min。术中室颤256例,其中181例自动复跳。全组死亡22例,其中复杂先天性心脏病15例,重症瓣膜病7例。全组无体外循环气栓并发症。结论浅低温体外循环方法在心脏跳动下心内直视手术中安全可行且易于管理,能有效避免心肌缺血-再灌注损伤。

Management of cardiopulmonary bypass for open heart surgery with beating heart

Objective To discuss the management methods of cardiopulmonary bypass（CPB） for patients underwent open heart surgery with beating heart.Methods The CPB management methods for 2 290 patients underwent open heart surgery with beating heart were summed-up.The left heart venting was established during the surgery and integrated sequetial de-airing procedure was conducted at the end of the surgery.The temperature of nasopharynx was maintained between 30～32 ℃,hematocrit was kept between 20%～30% and the flow was controlled between 2.4～3.2 L·m-1·min-2.α-stat blood gas strategies were applied,meanwhile conventional ultrafiltration or modified ultrafiltration was performed according to the condition.Results CPB went sucessful in all cases,the CPB time was 22～179 minutes.Ventricular fibrillation was occurred in 256 cases and 181 cases experienced automatic recovery to beating.There were 22 cases died including 15 cases of complex congenital heart disease and 7 cases of severe valvular heart disease.No complication correlated with perfusion was oberved.Conclusion Open heart sugery with beating heart under mild hypothermia by cardiopulmonary bypass is safe and feasible,meanwhile it is easy for management and it can effectively prevent ischemia reperfusion injury.