1600例重症心脏瓣膜置换术中的体外循环管理  

Experience of Cardiopulmonary Bypass Management of Serious Patients Underwent Heart Valve Replacement:1600 Cases Report

作　　者：殷凤珍[1] 李欣[1] 徐新根[1] 刁文瑜[1] 钱金兰[1] 吴金宝[1] 

机构地区：[1]上海市胸科医院体外循环室,上海200030

出　　处：《上海生物医学工程》2005年第1期8-9,19,共3页Shanghai Journal of Biomedical Engineering

摘　　要：目的报告1600例重症心脏瓣膜置换术中的体外循环管理技术。方法CPB中采用低液面预充、中度血液稀释、浅低温、HCT22～25%,心肌保护为高钾含血停跳液灌注。对心胸比例超过85%,合并肝大、腹水、肺长期淤血的患者,CPB中采用超滤法。结果体外循环时间90～357min,主动脉阻断时间50～170min,心脏停跳时间54～175min,术中灌注压55～70mmHg,中心静脉压0～5cmH2O,尿量平均200～800ml,自动复跳1047例,占65%。结论为了提高重症心脏瓣膜手术的体外循环质量,增加手术成功率,强调:(1)中度血液稀释,提高胶体渗透压;(2)CPB中用高钾含血停搏液作为心肌保护,必须做到按时、足量灌注;(3)及时补充碱性药物和电解质;(4)补充充足的镁离子可增加细胞内的钾离子浓度。Objective Summarize the cardiopulmonary bypass management experience of 1600 patients underwent heart valve replacement operation. Methods less volume priming, proper haemodilution, mild hypothermia , kept HCT between 22～25%,high potassium blood cardioplegia and ultrafiltration were used during bypass. Results The duration of cardiopulmonary bypass was 90 to 357 minutes, the cross clamp time was 50to 170 minutes, CVP was 0 to 5cmH 2O,urine was 200 to 800ml.The number of cardiac spontaneous resuscitation patients was 1047 (65%).Conclusion Such Perfusion measures were important to increase the success rate of serious pathological changed heart valve replacement.1.Proper haemodilution with higher colloid osmotic pressure.2.In time and sufficient perfusion of blood cardioplegia.3.Adding of alkaline and electrocyte. 4.Adding of ionized magnesium to increase intracellular potassium concentration.

关 键 词：术中 体外循环管理 重症心脏瓣膜置换术 CPB 中度 血液稀释 心肌保护 增加 合并 技术 

分 类 号：R654.1[医药卫生—外科学]