低温体外循环心室颤动下室壁瘤内修复及左室成形术  

Ventricular Endo-aneurysmorrhaphy and Left Ventricle Reconstruction under Ventricular Fibrillation on Hypothermia Cardiopulmonary Bypass

作　　者：徐东[1] 江龙[2] 李京宏[1] 尚学斌[1] 刘燕晖[1] 万峰[2] 

机构地区：[1]首都医科大学宣武医院心脏外科 [2]北京大学人民医院心脏外科

出　　处：《首都医科大学学报》2005年第2期190-192,共3页Journal of Capital Medical University

摘　　要：目的评估低温体外循环心室颤动(以下简称室颤)下室壁瘤内修复及左室成形术的临床效果.方法完成对14例室壁瘤患者(男12例,女2例)的手术,其中,在体外循环低温室颤下完成室壁瘤毡条外缝合1例;内毡片+外三明治左室成形术9例,包括附壁血栓取栓3例、二尖瓣成形1例;内荷包环缩+外三明治左室成形术4例,包括室间隔穿孔修补术1例.结果全组无1例死亡.体外循环时间43～168 min,平均(97±39)min;呼吸机使用时间8～50 h,平均(21±14)h.IABP(主动脉球囊反搏)使用率为43%(6/14);远端没搭桥1例;搭桥1根2例,搭桥2根5例,搭桥3根5例,搭桥4根1例.其中,乳内动脉桥3根,桡动脉桥2根,大隐静脉桥25根.术后1例因引流物较多而行2次开胸.结论低温体外循环室颤下室壁瘤内修复及左室成形手术是安全可靠的,低温室颤的心肌保护效果确实.Objective To study the clinical result of ventricular endo-aneurysmorrhaphy and left ventricle reconstruction under ventricular fibrillation (VF) on hypothermia cardiopulmonary bypass. Methods Operations were performed in 14 cases of ventricular aneurysm (male 12, female 2). Age range 51～75 average (63±7). NYHA Ⅳ 5 cases, Ⅲ 6 cases, Ⅱ 2 cases, Ⅰ 1 case, LVEF 10%～50%, (32±11)%. Myocardial infarction in 14 cases. 1 case was performed by direct felt strips suture under ventricular fibrillation on hypothermia cardiopulmonary bypass. 9 cases were done by endo-aneurysmorrhaphy using felt patch plus outside sandwich left ventricle reconstruction in the same way, including 3 cases with thrombus removal, and 1 case with mitral valve repair. 4 cases were performed by endo-aneurysmorrhaphy using inside per-string suture plus outside sandwich left ventricle reconstruction by the same myocardial protection method, including 1 case with ventricle septal perforation repair. Results Mortality of this study was zero. CPB time was 43～168 min, (97±39) min, Ventilation time was 8～50 h, (21±14) h, 6 cases were supported by IABP. No graft for 1 case, one graft with 1 case, two grafts with 5 cases, three grafts with 5 cases, four grafts in 1 case, totally three LIMA grafts, two RA grafts and 25 vein grafts were used in this study. One case was reopened for bleeding. Conclusion The procedure of ventricular endo-aneurysmorrhaphy under ventricular fibrillation on hypothermia cardiopulmonary bypass is safe. The result of myocardium protection of hypothermia ventricular fibrillation is satisfactory.

关 键 词：低温体外循环 心室颤动 成形术 左室 修复 瘤内 主动脉球囊反搏 体外循环时间 心肌保护效果 低温室颤 二尖瓣成形 穿孔修补术 乳内动脉桥 大隐静脉桥 临床效果 附壁血栓 桡动脉桥 安全可靠 成形手术 室壁瘤 搭桥 内荷包 

分 类 号：R654.2[医药卫生—外科学] R541.75[医药卫生—临床医学]