体外循环心内直视手术1097例报告

目的探讨心脏不停跳心内直视手术的意义和手术适应征。方法心脏不停跳法：阻断上下腔、不阻断冠脉循环，不用心脏停搏液；鼻咽温缓慢降至（33±1）℃，在心脏有节律的空跳中完成手术操作。主动脉瓣置换等要切开主动脉根部的手术，经冠状静脉窦持续逆行灌注。心脏停跳法：降温至32～28℃±1℃，阻断主动脉后从其根部灌注4℃晶体或15℃血K^＋心停跳液，每间隔30min复灌1次。室缺补片修补等心内操作完毕开放主动脉阻断，心脏复跳后完成其余手术操作。结果术后并发低心排综合征8例（0．74％），血红蛋白尿46例（4．19％），急性肾功能衰竭7例（0．64％），Ⅲ度房室传导阻滞1例（0．09％），精神症状7例（0.64％），消化道出血1例（0．09％），死亡28例（死亡率2．55％）。结论心脏不停跳法是一种较接近生理状态的心肌保护新方法，获得较理想的临床效果，可适用于绝大部分常规心内直视手术。

Clinical report of 1097 cases for open heart surgery with beating heart

Objective Study on the clinical meaning and value of open heart surgery with beating heart. Methods As CPB, aortic root was not cross-clamped and no cardioplegia solusion was used. Myocardium was perfused with oxygenated blood via aortic artery. When cross-clamp needed, myocardium was retrogradely perfused via coronary sinus fore aortic valve or aortic valve combined with mitral valve replacement. Nasopharyngie temperature was kept at （33 ±1）℃. Operation was performed on the slowly and emptily beating heart in 1097 cases. Cold blood cardioplegia solution （15℃） was infused at intervals in 87 cases. Results Pump stopped immidiately while operation finished. Only a few patient needed low dose of dopamine to support circulation. The incidence of low cardiac output syndrome was 0.73 % （8/1097）. No episode of air embolism was seen. The rate of hemoglobinuria, which was in positive relation to the time of CPB, was 4.19 （46/1097）%. There was 28 operative death with a mortalily of 2.55% （28/1079）. Conclusion Continuously warm blood perfusion on beating heart is an good myocardial protection way closing to physiologic state, idial clinical effect can be abtained, it is suitable to almast open heart surgery.