体外循环心脏跳动中心内直视手术2100例临床分析

目的探讨完善浅低温体外循环心脏跳动中心内直视手术技术,报告2100例临床应用经验。方法改良浅低温体外循环心脏跳动中心内直视手术技术,建立同期左心房左心室引流和综合序贯排气技术,改善手术野显露,完善术中排气。应用该技术实施心脏手术2100例,男981例,女1119例。其中先天性心脏病1442例,心脏瓣膜病658例。结果全组手术死亡率为1.67%(35/2100),其中先天性心脏病手术死亡率1.87%(27/1442),心脏瓣膜病手术死亡率为1.22%(8/658)。全组无体循环气栓和永久性房室传导阻滞发生。结论浅低温体外循环心脏跳动中心内直视手术技术安全可行,可有效减轻低温和缺血再灌注对心肺等脏器的损伤作用,有利于避免术中心脏传导阻滞的发生。

On-Pump Beating-Heart Intracardiac Procedures in 2100 Cases

OBJECTIVE To improve intracardiac operation technique on beating-heart with mild hypothermic extracorporeal circulation(On-pump beating-heart technique),and to review the clinic experience in 2100 cases.METHODS 2100 cases received intracardiac operations on-pump beating-heart technique.1442 patients of them were with congenital heart diseases(CHD),and 658 with valvular heart diseases(VHD).The operative technique was improved with establishing simultaneous left atrium and ventricle suction and integrated sequential de-airing procedure.RESULTS The operative mortality was 1.67% (35/2100),while the mortality was 1.87%(27/1442) in patients with CHD,and 1.22%(8/658) in those with VHD.There was no patient complicated with systemic air embolism or permanent atrioventricular conduction block.CONCLUSION Our results suggested that on-pump beating-heart was a reliable technique for intracardiac procedures in patients with CHD or VHD.The technique might extenuate heart and lung injury by hypothermia and ischemia-reperfusion during cardiopulmonary bypass.Cardiac conduction tissue was prevented from operative injury while heart beating.