微创心脏外科手术中体外循环管理

目的总结我院微创心外科手术体外循环管理的初步经验。方法我院自2010年4月至2011年3月,96例患者进行了右前小切口微创心脏外科手术,均经外周插管建立体外循环,术中应用负压辅助静脉引流装置（VAVD）。年龄12～73岁,体重40～95 kg,男性38例（39.6%）,女性58例（60.4%）,瓣膜病行瓣膜置换术55例（57.3%）,先天性心脏病行根治术40例（41.7%）,瓣膜病合并冠心病行冠状动脉旁路移植术1例。结果全组无围手术期死亡。体外循环时间36～260（111.5±104）min;心脏阻断时间20～204（71.7±74.5）min;ICU停留时间4～38（18.4±5.6）h;术后住院时间3～24（6.9±2.2）d;1例术中因颈内静脉引流不畅,改经胸上腔静脉插管,1例因术中主动脉根部出血无法控制,改为胸骨正中切口。无股动脉插管相关并发症。术后无输血65例（67.7%）。结论患者近期手术疗效满意。外周插管建立体外循环和术中VAVD的合理应用,为术中体循环灌注充分提供了安全保证。

Perfusion management during minimally invasive cardiac surgery

Objective Minimally invasive cardiac surgery(MICS) has become standard practice at many institutions.Peripheral cardiopulmonary bypass(CPB) was mandatory for achieving excellent exposure.Methods From April 2010 to March 2011,96 patients underwent MICS through a small anterior thoracotomy at our hospital.CPB accomplished with peripheral cannulation and vacuum assisted venous drainage.Results The mean CPB time was 36-260(111.5±104) mins,mean aortic clamping time was 20-204(71.7±74.5) mins,mean ICU stay was 4-38(18.4±5.6) hours,transfusion free was 65 cases(67.7%).There was no in hospital death.One case converted to full sternotomy because of uncontrolled aortotomy bleeding.One case was poor venous drainage from right internal jugular vein,and then the cannular was removed and re-inserted to SVC through another small chest wall incision.Conclusion We have achieved satisfied short term outcomes at our early minimal invasive cardiac surgery practice.Optimal venous drainage can be provided by dual peripheral venous canulation combined with vacuum assisted venous drainage.