浅低温不停跳体外循环方法在重症搭桥手术中的应用

目的:总结重症患者在浅低温不停跳体外循环(extracorporeal circulation,ECC)下行冠状动脉旁路移植手术的效果。方法:2010年1月至2011年5月对34例择期行冠状动脉旁路移植术(coro-nary artery bypass grafting surgery,CABG)的重症患者(左主干病变、左心室舒张末期内径>60 mm、左心室射血分数<40%、术前Euroscore评分>6分、术前心源性休克、急性心肌梗死)施行浅低温ECC下不停跳CABG,术前均存在不稳定型心绞痛。其中10例(28%)合并糖尿病。3例(44%)患者术前应用了主动脉内球囊反搏(intra-aortic ballon pump,IABP)。分析总结重症CABG患者体外循环管理经验。结果:平均ECC时间68 min(42～123 min),机械通气时间平均18 h(6～84 h),ICU滞留时间平均2 d(14h～14 d),住院时间平均22 d(10～34 d)。12例患者术后应用IABP。无与ECC相关的神经系统并发症,肾功能不全6例(18%),并应用肾替代疗法。死亡2例(6%)。结论:对严重心功能不全或血管条件不好的重症CABG患者,采用浅低温不停跳ECC是一种安全可靠的手术方法。

The application of mild hyperthermia extracorporeal circulation in coronary artery bypass grafting for severe coronary artery disease patients

Objective:To summarize the clinical characteristics of coronary artery bypass grafting in 34 patients with severe coronary artery disease under mild hyperthermia extracorporeal circulation.Methods:34 consecutive patients with Left main disease、LVEDD>60 mm、EF<40%、Euroscore>6、heart failure or AMI,were scheduled for beating heart CABG under mild hyperthermia extracorporeal circulation.All 34patients had unstable angina,10(28%)patients had diabetes,15(44%)patients had old myocardial infarction and 15(44%)patients were referred to Intra-aortic ballon pulsation(IABP) pre-operative.Results:There are2(6%)died.The mean ECC time is 68 min(42-123 min),mean ventilation time is18 h(6-84 h),mean ICU stay time is 2 days(10-34 d) and hospitalization time is 22 d(10-34 d).We had12 patients inserted IABP post-operative,only 3 pre-operative.No patient suffered nervous system related complications but 6(18%) patients had renal failure and applied ranal replace therapy.Conclusion:Beating heart CABG under mild hyperthermia extracorporeal circulation is safe and reliable for CAD patients with impaired left ventrical function or poor target vessels.