主动脉瓣和二尖瓣联合置换术的体外循环管理体会

目的回顾性总结主动脉瓣和二尖瓣联合瓣膜置换术（DVR）的体外循环（CPB）经验。方法31例DVR患者，男15例，女16例，年龄30～62岁，中度低温CPB下行DVR，采用膜肺；预充白蛋白或新鲜冰冻血浆和人工胶体，必要时术中追加；心肌保护应用10℃～15℃4：1（血：晶体）高钾停搏液灌注；CPB中维持灌注流量50—100ml／kg和平均动脉压（MAP）50～90mmHg；开放前应用利多卡因、硫酸镁和碳酸氢钠；后并行期应用超滤、悬浮红细胞、速尿等提高Hct。结果CPB时间137～254（182．7±38．0）min，升主动脉阻断时间91～168（129．8±26．40）min，自动复跳率74．2％（23／31），血红蛋白尿发生率35．5％（11／31），全组均脱机，无手术死亡。结论DVR的CPB应注意提高胶体渗透压，注意心肌保护，重视血球压积的监测和调节，采取综合措施是保证CPB成功的关键。

Management of Cardiopulmonary Bypass on Patients Undergoing Double Valve Replacement Operations

OBJECTIVE To summarize the clinical experience of cardiopulmonary bypass （CPB） in double valve replacement. METHODS 31 patients （Male 15,Female 14） aged from 30 to 62 years old underwent, double valve replacement under hypothermic CPB. The membrane oxygenator was selected. The human albumin, fresh - frozen plasma and artificial colloids were primed and added during CPB if necessary. Myocardial protection was performed with blood crystalloids（4： 1 ）hyperkalemia cardioplegia. High perfusion flow 50 - 100 ml/kg and high mean arteria pressure 50 -90 mmHg was performed during CPB. Ultrafiltration technique, suspened red blood cell, and furosemide were used for the raise of Hct during late CPB. RESULTS CPB time and aortic cross - clamp time was 137 - 254 min and 91 - 168 min respectively. The incidence of automatic heart resuscitation was 74.2% （23/31）. None of the patients died during surgery. All patients weaned successfully from CPB. CONCLUSION Management of CPB on patients with double valve replacement operations should focus on the raise of blood colloids pressure, the myocardial protection and the monitoring and control of Hct during CPB. The comprehensive measures maybe the key for the success of CPB.