离心泵辅助股静脉引流应用于微创心脏瓣膜手术的体外循环管理经验

目的总结离心泵辅助股静脉引流应用于微创心脏瓣膜手术的体外循环(ECC)管理经验。方法我院自2009年7月至2009年12月共开展经右肋间小切口心脏瓣膜手术共64例(男23例,女41例),其中二尖瓣置换(MVR)24例,二尖瓣成形(MVP)23例,主动脉瓣置换(AVR)16例,双瓣置换(DVR)1例。全组患者使用双腔气管插管全麻,常规全身肝素化后,使用Edwards 18~20 Fr的股动脉和24~28 Fr的股静脉插管建立ECC,股静脉由下腔静脉经右房达上腔静脉口,侧孔位于右房,将离心泵串连于静脉回路。根据引流情况调节离心泵负压动力增加静脉引流,满足灌注流量及手术视野的要求。记录不用离心泵辅助时的最大静脉引流量(D1),以及在离心泵辅助下能达到的最大静脉引流量(D2)。结果①全组患者ECC时间51~181(84.8±23.9)min,主动脉阻断时间20~118(47.7±17.5)min,术中转流平稳,血流动力学稳定,监测SvO2、血气及尿量等指标均在正常范围,手术视野暴露良好,无延长切口或转正中切口病例,无手术死亡病例;②全组患者D11.2~2.5(1.74±0.32)L/min,D21.9~3.6(2.69±0.43)L/min,离心泵转速335~1330(881±215)r/min,D2比D1平均增加57.7%,两者比较有显著性差异;③比较24Fr与28Fr的股静脉插管引流量无显著性差异。结论离心泵辅助股静脉引流能增加股静脉的引流量,满足全身所需的灌注流量及手术视野要求。

Extracorporeal circulation experience of centrifugal pump-assist venous drainage in minimally invasive cardiac surgery

OBJECTIVE To summarize the extracorporeal circulation（ECC） experience of centrifugal pump-assist venous drainage in minimally invasive cardiac surgery.METHODS Total 64 patients（23 men,41 women）underwent minimally invasive cardiac surgery from July 2009 to December 2009,included 24 MVR,23 MVP,16 AVR and 1 DVR.After general anesthesia with double-lumen tube intubations and heparinzing,ECC was established with Edwards 18-20Fr femoral artery catheter and 24-28Fr femoral venous catheter.The femoral venous catheter reached orifice of superior vena cava though right atrium and the side port should be in the right atrium.The centrifugal pump was connected to the venous line.In order to meet the need of the perfusion flow and the operation field,the kinetic negative pressure was regulated to augment the venous drainage.The maximal drainage without the centrifugal pump（D1） and with the centrifugal pump（D2） was recorded.RESULTS ①For all patients,ECC time was 51-181（84.8±23.9）min and aortic cross-clamp time was 20-118（47.7±17.5）min,all the parameters were in the normal range.The surgeons could get good operation fields.② For all patients,D1 was 1.2-2.5（1.74±0.32）L/min,D2 was 1.9-3.6（2.69±0.43）L/min,the rotation speed of the centrifugal pump is 335-1330（881±215）r/min,D2 was 57.7% higher than D1.There is a significant statistical difference for the drainage between D1 and D2.③There is no significant statistical difference for the drainage between 24Fr and 28Fr femoral venous catheter.CONCLUSION The centrifugal pump-assist venous drainage could meet the need of the perfusion flow and the operation field.