老年重症瓣膜病手术的体外循环管理

目的总结大于70岁的老年重症心脏瓣膜病施行瓣膜手术过程中体外循环（cardiopulmonary bypass,CPB）的管理经验。方法从2004年09月至2008年12月,共对71例老年重症心脏瓣膜病患者（7081岁）施行瓣膜置换或成形手术,术前进行全面评估和充分准备,术中采用浅-中低温、中-高流量CPB,维持平均动脉压（MAP）6090 mmHg,血红细胞比容（Hct）0.250.30。结果主动脉瓣或二尖瓣单瓣置换38例,双瓣置换16例,二尖瓣或主动脉瓣成形17例。其中11例同时行冠状动脉旁路移植术（CABG）术,3例行升主动脉人工血管置换术,3例行带瓣管道升主动脉置换术。无手术死亡,术后早期死亡5例,其中4例死于多脏器功能衰竭,余1例死于恶性心律失常。结论在合理的CPB管理下,对老年重症瓣膜病患者患者进行心内直视手术是积极安全有效的。

Cardiopulmonary Bypass Management of Valve Surgery in the senior Patients

OBJECTIVE This clinical study summerized cardiopulmonary bypass（CPB） management of valve surgery in the senior cases.METHODS From September 2004 to December 2008,71 cases of senior patients with severe valvular heart disease received valve replacement or repair.During cardiopulmonary bypass,mild to moderate hypothermia and middle to high flow rate was used to keep perfusion pressure at 60-90 mmHg,and keep the hematocrit（Hct） at 0.25-0.30.RESULTS 38 patients underwent isolated aortic or mitral valve replacement.16 patients underwent aortic and mitral valve replacement.17 patients underwent isolated aortic or mitral valve repair.The concomitant operations included 11 CABG,3 ascending aorta replacement and 3 Bentall procedure.There was no death related to operations.5 patients died early after surgry,4 died of multiple organ failure and 1 died of arrhythmia.CONCLUSION With effective CPB management,valve surgery in senior is safe.