体外循环下手术治疗35例重症心瓣膜病患者资料的回顾性分析

目的探讨并总结体外循环下行重症心瓣膜病外科手术中体外循环的管理方法。方法回顾性分析35例心瓣膜置换术患者的临床资料,体外循环下行二尖瓣置换术10例,主动脉瓣置换术7例,二尖瓣并主动脉瓣置换术7例,二尖瓣置换术合并冠状动脉旁路移植术5例,主动脉瓣置换术合并冠状动脉旁路移植术4例,二尖瓣、主动脉瓣置换术合并冠状动脉旁路移植术2例;流转期间灌注压维持60⁷0 mm Hg,中心静脉压070 mm Hg,中心静脉压0⁵ cm H2O,对合并冠状动脉旁路移植术患者采用顺灌+逆灌相结合的灌注方法,所有患者均采用超滤技术,记录患者体外循环时间、主动脉阻断时间及心脏复跳比例及手术结局。结果体外循环时间为(189.5±44.8)min;升主动脉阻断时间为(115.4±28.5)min;心脏自动复跳率为88.6%,除颤复跳率为11.4%;体外循环中患者均成功脱机;术后2例(5.7%)死于合并肾衰竭、多器官功能障碍综合征。结论选择合适的灌注方法、进行心肌和肾脏保护、适时采用超滤技术、准确掌握脱机指征是确保手术成功的重要环节。

Retrospective Study on Clinical Records of 35 Cases of Patients with Severe Valvular Heart Diseases Treated with Surgical Operation under Extracorporeal Circulation

Objective To discuss the management of extracorporeal circulation during severe cardiac valve surgeries.Methods Clinical records of 35 cases of patients treated with cardiac valve replacement surgeries were retrospectively analyzed,among which,ten cases were treated with MVR surgery under extracorporeal circulation,seven cases were treated with AVR,seven cases were treated with DVR,and five cases were treated with MVR ＋ CABG,four cases were treated with AVR ＋ CABG,another two cases were treated with DVR ＋ CABG;during extracorporeal circulation perfusion pressure was maintained at 60-70 mm Hg,CVP at 0-5 cm H2O,and antegrade perfusion ＋ reverse perfusion methods were combined together for the cases treated with CABG operation,uhrafihration technology was applied to all cases;and cardiopulmonmy bypass time,aortic cross-clamp time and cardioversion rate as well as the operation outcome were noted.Results Cardiopulmonary bypass time wa（189.5 ± 44.8） min ; ascending aortic cross-clamp time was （115.4 ± 28.5） min.automatic cardioversion rate was 88.6%,defibrillation and cardioversion rate was 11.4%.During cardiopulmonary bypass,all cases got off machine successfully,two cases died of postoperative renal failure and MODS.Conclusion Selecting appropriate perfusion methods,implementing myocardial and renal protection,timely applying ultrafiltration technology,and accurately monitoring the offline indication are important steps for securing success of cardiac the operation.