胸腔镜辅助微创心脏手术体外循环管理

目的回顾性总结胸腔镜辅助下微创心脏手术的体外循环（ECC）经验。方法自2009年3月至2011年11月共行腔镜辅助右侧开胸心脏微创手术32例,采用浅低温ECC,股动、静脉插管15例,股动、静脉插管加右颈内静脉插管15例,股动脉及右颈内静脉插管2例。ECC中予以负压辅助静脉引流（VAVD）。心肌保护采用含血停搏液灌注法12例,HTK液灌注法18例,不停跳2例。术中经食道超声（TEE）帮助下心腔排气并观察心脏情况。结果所有病例ECC中引流充分,ECC时间（86.1±25.2）min,升主动脉阻断时间（48.2±13.9）min,开放后自动复跳13例,辅助时间（30.5±16.6）min,超滤量（980.5±468.2）ml,转中尿量（685.7±316.5）ml,全部痊愈出院。结论股动、静脉插管ECC适于胸腔镜辅助微创心脏手术,VAVD技术保证了ECC静脉引流通畅,右颈内静脉插管是一种安全可行的上腔静脉引流措施,TEE对于观察心脏功能状态、指导心脏排气具有重要作用。

Cardiopulmonary bypass management during thoracoscope assisted minimally invasive cardiac surgery: 32 cases reports

Objective To summarize experiences of extracorporeal circulation （ECC） management in thoracoscope assisted minimally invasive cardiac surgery （TAMICS）. Methods Between March 2009 and November 2011, 32 patients underwent TAM- ICS. ECC cannulas were established through femoral artery and femoral vein （ n = 15 ） or through femoral artery, femoral vein and right internal jugular vein （n = 15 ） or just through femoral artery and right internal jugular vein （n = 2）. Vacuum -assisted venous drainage （VAVD, -25mmHg ~ -60mmHg） was implemented during ECC. Myocardial protection was accomplished by blood cardiople$ia per- fusion （n = 12 ）, CUSTODIOL HTK solution （ n = 18 ） or by keeping own heartbeat （ n = 2 ）. Transesophageal echocardiography （TEE） was applied in all cases to help heart venting before and after cross - clamping opening. Results All cases had sufficient ECC drainage, ECC time was 86.1 ~ 25.2 rain, the aortic cross - clamping time was 48.2 ±13.9 rain, 13 cases recovered automatic heart rhythm, ECC assisted time was 30.5 ± 16.6rain, ultrafiltration volume was 980.5± 468.2 ml, the urine volume was 685.7 ±316.5 ml during ECC. All patients discharged. Conclusion ECC cannulation via the femoral vessels is suitable for TAMICS. VAVD techniques can ensure ECC venous drainage sufficiently. The right internal jugular vein catheter used for ECC drainage of superior vena cava is safe and feasible. TEE is very important for surgeon to vent the heart and to understand the heart conditions during TAMICS.