急性重症感染性心内膜炎手术的体外循环管理

目的 探讨急性重症感染性心内膜炎(Infective endocarditis,IE)心脏直视手术的体外循环管理.方法 回顾性分析2005年1月至2010年3月本院43例IE患者体外循环(CPB)下心脏手术的资料.CPB采用中低温、中度血液稀释、中高流量[2.4～3.0L/(min·m2)],7℃～10℃稀释血停搏液顺灌进行心肌保护.术前溶血性贫血39例;肝功能不全10例;肾功能不全12例;外周血管栓塞13例.结果 CPB时间(61.47±17.53)min,阻断时间(47±18.4)min.本组患者术后早期死亡3例,胸部切口感染1例,急性肾功能衰竭1例,消化道出血1例.结论 IE患者术前并发症的评估、体外循环中对症处理,对患者的治疗和恢复至关重要.

The management of cardiopulmonary bypass on the patients of in fective endocarditis

Objective To investigate the management of cardiopulmonary bypass （CPB） on the patients of infective endocarditis. Methods To summarize retrospectively the experience of management of cardiopuhnonary bypass （CPB） during Open Heart Surgery t for infective endocarditis in 43 cases from2005.1 to 2010.3. CPB adopted mild hypothermia, moderate hemodilution, high flow [ 2.4 - 3.0L/（ min · m^2 ） 1- Cardioplegia with 4℃. cold crystalloid or 7 ℃ - 10℃ 4 ： 1 （ blood ： crystalloid ） Preoperative hemolytic anemia 39 cases;liver dysfunction 10 cases ;renal dysfunction 12 cases. Results The duration of CPB ranged from 43.47to 89.40 min, and aorta cross - clamp time （ ACC ） from 29. 6to 65.4 min. Three cases died early postoperatively due to thoracic infection of incisional wound; acute renal failure; alimentary tract hemorrhage. Conclusions The key points to success are evaluating the complication accurately,and well treament during the CPB.