不停搏的心内直视手术

目的 :总结不停搏心内直视手术 2 7例 (法乐三联症 5例、法乐四联症 1例、肺动脉瓣狭窄 4例、继发孔房间隔缺损直径 >3.5cm4例、室间隔缺损 8例、右肺静脉畸形引流 1例、亚急性细菌性心内膜炎 ( SBE)合并三尖瓣赘生物 1例、主动脉窦瘤破裂 1例、双腔右心室 2例 )经验 ,并介绍了术中注意事项 ,特别是预防空气栓塞的具体方法。　 方法 :本组均在静脉复合全麻下 ,全身肝素化后插入主动脉灌注管和上、下腔静脉引流管、主动脉根部插排气针 ,在常温下进行体外循环 ,并根据不同病变选择心脏切口 ,在心脏搏动的情况下进行心内畸形矫治修补术。　 结果 :本组除1例发生术后轻微的脑梗塞症状经高压氧舱治疗 3次恢复外 ,余均保持术后良好的心功能 ,既无严重低心排综合征发生 ,也无严重心律失常 ,全组患者均顺利康复出院。手术时间比心脏停搏的心内直视手术平均缩短 30～ 4 0 min,术后住院天数也明显缩短。　 结论 :该方法只要应用得当 ,可以增加体外循环心脏手术的安全性 ,尤其是术中不易损伤心脏的传导系统 ,缩短了手术时间 ,减少了并发症 ,术后心功能良好

Open- heart surgery with heartbeating

Objectives:In this paper,we reviewed our experiences of2 7open- heartoper- ations with heart beating in our department. These included 5 cases of Trilogy of Fallot,1 case of Tetralogy of Fallot,4cases of Pulmonary stricture,4cases of ASD(the diameter> 3.5 cm) ,8cases of VSD,1 case of Abnormally Right Pulmonary Vein Drainage,1 case of SBE with Tricuspid bacterial vegetation,1 case of Ruptured Aneurysm of the Sinus of Val- salva,and2 cases of Double Chambers of the Right Ventricle.The experiences and ways to avoid air embolism were introduced. Methods:All the patients were under general anes- thesia and heparinized,the aortic perfusion cannula and venae cavae cannula were inserted, extracorporeal circulation were setup in normal temperature during the open- heart operations with heart beating. Incisions were made according to the different types of the heart disor- der. Results:Except for one case of mild air embolism in the brain vessel thatwas cured by 3times of hyperbaric oxygenation,all patients met with excellent heart functions after the operations,low output syndrome or severe arrhythmia did not appear.The operative time was30 to40 minutes shorter than the conventional open- heartsurgeries.Days ofhospitaliza- tion of all patients in this group were also much shorter. Conclusions:If applied properly, the procedure could increase the operative safety,avoid damage to the conductive sytem, shorten the operative time,decrease postoperative complications and maintain excellentheart functions after the operations.