65岁以上老年患者心脏瓣膜手术中的体外循环管理

【目的】 总结65岁以上老年人心脏瓣膜置换术的体外循环管理方法。【方法】 2006年1月至2008年12月，开展了232例老年人心脏瓣膜置换术，其中男133例，女99例，年龄65～78岁(69.6±9.2)岁；体重39～81Kg（51±8.2）Kg。手术方式包括二尖瓣置换术(MVR)73例，主动脉瓣置换术(AVR)51例，三尖瓣置换( TVR)3例，二尖瓣及主动脉双瓣置换术(DVR)93例，再次二尖瓣置换术(Re-MVR)7例，再次主动脉瓣置换术(Re-AVR)3例，主动脉带瓣人造血管置换2例，同期行二尖瓣整形(MVP)21例，三尖瓣整形( TVP)66例，冠状动脉旁路移植术(CABG)12例。全部采用气管插管、静吸复合麻醉，中度血液稀释、中度低温、中高流量，冷含血停跳液进行心肌保护，全部应用超滤器。【结果】：体外循环时间46～315min(87.2±32.7)min；主动脉阻断时间25～168min(58.3±27.5)min。转流中平均动脉压维持在6O～90mm Hg，超滤量为800～8300ml，心脏自动复跳率86％，本组早期死亡10例(4.3％)。【结论】 体外循环中加强心肌保护；控制血液稀释度，使用血液超滤技术维持机体内环境的稳定；有效的组织灌注以及良好的保护等综合性措施，有助于脑、肾、肺等重要脏器的保护,有利于提高老年患者心脏瓣膜置换术中体外循环的质量，并确保手术安全

Extracorporeal circulation management in heart valve replacement of old patients over 65 years

Objective: To summarize the experience of extracorporeal circulation in old patients with heart valve disease. Methods: Two hundred and thirty two patients aged from 65 to 78 years old, weighting from 37 to 87 kg, underwent valvular surgical procedures from Jan.2006 to Dec.2008. There were 133 males and 99 females. All patients were administrated with combined intravenous and volatile anesthesia. Management of extracorporeal circulation including medium hemodilution, medium to high flow, cold blood cardioplegia and ultrafiltration was applied in each patient. Results: The mean bypass time was 87.2±32.7 min. Mean cross-clamp time was 58.3±27.5 min. Mean arterial pressure was maintained from 60 to 90 mmHg during bypass. Therate of automatic heart beating after cross-clamp removing was 86%.The early mortality was 4.3%. The reasons of mortality included multi-organs failure, low cardiac output syndrome and etc. Conclusions: To improve the quality of extracorporeal circulation in old patients over 65 years old during valular surgical procedures, the comprehend managements including hemodilution, organs protection, ultrafiltration and effective tissue perfusion were important.