常温体外循环心脏停跳在心脏手术中的应用

目的探讨常温体外循环心脏停跳法在心脏手术中的应用技术及围术期管理。方法将66例不同心脏病种按所用氧合器不同分成膜式氧合器组（M组）及鼓泡式氧合器组（x组）,全部患者均采用静脉复合麻醉,高流量灌注2．4—2．6L／（min．m^2）,间断灌注2℃-4℃Thomas冷晶体停跳液,体外循环转流期间使用循环血液保温,全身温度保持在35℃-37℃,心包腔内不放置冰屑。比较两组心脏复跳情况、术后引流量及呼吸机使用时间,评估该技术在不同氧合器类型对心、肺及凝血机制的影响有何差异。结果两组无死亡病例,无低心排,无肺、脑、肾等重要脏器并发症发生。两类氧合器在心脏复跳、术后引流液量及呼吸机使用时间差异无统计学意义（P〉0．05）。结论常温体外循环心脏停跳法应用于预计手术时间较短和肺侧支循环较少的非紫绀性心脏病的心内直视手术,围术期心肌及其他重要脏器功能保护可靠,简单易行。

Clinical application of arrested heart with normothermic cardiopulmonary bypass during open-heart surgery

Objective To investigate the ambient temperature during cardiopulmonary bypass heart surgery in the heart of the application of technology and perioperative management. Methods 66 cases of different types of heart disease, were divided into membrane oxygenator oxygenator group （M） and the bubble oxygenator group （X） , and all patients used intravenous anesthesia, high - flow reperfusion 2.4L/min/m^2 - 2.61-/min/m^2 , continuous infusion 2 -4℃ thomas cold crystalloid cardioplegia, bypass pump blood during.the use of recycled insulation, to maintain body temperature at 35 - 37℃, pericardial cavity ice crumbs not placed. Comparing the two groups jumped at the heart of complex situations, postoperative drainage and ventilator time to assess the use of the technology in different types of oxygenator for heart, lung and blood coagulation mechanisms. Results There were no dead case, no low cardiac output, non -lung, brain, kidney and other organ essential complications. There were no significant difference of rehabilitation jump, the amount of fluid drainage and ventilator time between two groups. Conclusion Arrested heart with normothermic cardiopulmonary bypass can be employed to the shorter and less pulmonary collateral circulation of the non - cyanotic heart disease undergoing open heart surgery, with the reliable perioperative myocardial protection.