右腋下小切口心内直视手术中的体外循环管理

目的总结右侧腋下小切口心脏直视手术体外循环管理的经验。方法 2010年1月至2011年8月我们采用右侧腋下小切口实施心脏直视手术83例,其中男性27例,女性56例;年龄7个月～59（8.0±9.1）岁;病种包括房间隔缺损修补21例（不停跳18例,同期行三尖瓣成形3例,二尖瓣成形1例）,室间隔缺损60例（同期行右室流出道疏通4例）,完全性肺静脉异位引流1例,右室双出口1例。回顾分析体外循环中主动脉插管选择、灌注方法、灌注压力、转流时间以及心脏复跳情况。结果主动脉弯头插管69例,直头插管14例;其中弯头插管出现高阻力泵压5例,1例更换为直头插管,其余4例调整插管位置后泵压恢复正常;直头插管中无高阻力泵压出现。体外循环时间21～185（66.9±32.3）min;升主动脉阻断时间5～122（32.5±25.5）min。80例自动复跳,自动复跳率96.4%。3例经电击除颤1次后心脏复跳。全部病例都顺利脱机。术后无神经系统并发症发生。结论右侧腋下小切口选择性应用于先天性心脏病心内直视手术,具有安全可靠、创伤小、切口美观等优点;稳定可靠的体外循环、正确的管理以及紧急情况下的配合处置是手术成功的保证。

Management of extracorporeal circulation during cardiac surgery through minimal right infra-axillary incision

Objective To summarize the experience of extracorporeal circulation （ECC） during cardiac surgery through mini- mal right infra - axillary incision. Methods A total of 83 patients （ male 27, female 56） of congenital heart disease were undertaken surgery with ECC through minimal right infra - axillary incision between January 2010 and August 2011. The age ranged from 7 months to 59 years old （mean 8.0 ~ 9.1 years old）. There were 21 cases of atrial septal defect repair （including 18 cases of operation on beat- ing heart, 3 cases tricuspid valve repair and one case of mitral valve repair simultaneously）, 60 cases of ventricular septal defect repair （ including 4 cases of correction of right ventricular outflow tract stenosis simultaneously）, one case of correction of total anomaly pul- monary vein connection, and one case of correction of double - outlet right ventricle. The ECC data was analyzed retrospectively. Re- suits Right - angled and straight - tip aortic cannulas were applied in 69 and 14 cases respectively. Because of high pump pressure right - angled cannula were adjusted orientation in 4 cases and transposed to straight - tip one in one case. The ECC time ranged from 21 - 185 min （ mean 66.9 ＋ 32.3 min）, and aortic cross - clamping time ranged from 5 - 122 rain （ mean 32.5 ~ 25.5 rain）. Eighty cases re - beat automatically, while 3 cases re - beat after defibrillation. All cases ware off pump successfully and there were no neuro- logical complications postoperatively. Conclusion It is important to manage reliable extracorporeal circulation correctly, when per- forming cardiac surgery through the right infra - axillary incision, which could provide a safe, mini - invasive, and superior cosmetic result.