西宁地区不停跳心内直视手术治疗(附40例报告)

目的 :探讨西宁地区 (海拔 2 2 6 0m)心脏不停跳心内直视手术方法和意义。方法 :4 0例施行心脏不停跳心内直视手术 ,并行循环 ,阻断上、下腔静脉而不阻断升主动脉 ,不使用心脏停搏液 ,保持心脏处于空跳、慢跳状态下 ,浅低温 33℃± 1℃ ,完成心内直视手术。结果 :心内直视手术术毕即可停机 ,术后血流动力学平稳 ,血管活性药物用量少 ,无低心排及严重心律失常、无空气栓塞、无其它脏器损伤、术毕即可拔管 ,无一例手术死亡。结论 :浅体温、体外循环、心脏不停跳心内直视手术避免了心肌缺血再灌注损伤 ,有很好的心肌保护效果 ,为一种更接近生理状态下的心肌保护方法 ,减少体外循环并发症的发生 ,更适应在高原地区缺氧地区应用

Clinical Observation of Intracardiac Surgery Under Beating Direct Vision at High Altitude

Objective: To evaluate the clinical experience of intracardiac surgery under beating heart direct vision. Methods:40 patients (19 males, 21 females aged 3 to 32, mean 17.5 years old) in our hospital from 2001 to 2002 received open heart surgery with cardiopulmonary bypass(CPB) under intracardiac beating direct vision. And we maintained the heart beat slowly without using cardiac arrest liquid. Results:The change of hemodynemics was mild as well as usage of vasoactive drugs. The incidence of low cardiac output syndrome was less; There were no serious arrhythmia, air embolism and other organ injury. Conclusions:The intracardiac surgery under beating heart direct vision and low temperature can prevent the reperfusion injury of myocardium. It is available way in cardiosurgery at high altitude.