序贯式双肺移植中应用体外循环经验探讨  

The Role of Cardiopulmonary Bypass in Bilateral Sequential Lung Transplantation

作　　者：徐凌峰[1] 李欣[1] 郭震 朱金洪[1] 吴金宝[1] 刁文瑜[1] 钱金兰[1] 王华[1] 杨义斌[1] 

机构地区：[1]上海市胸科医院体外循环室,上海200030

出　　处：《中国体外循环杂志》2005年第3期167-169,共3页Chinese Journal of Extracorporeal Circulation

摘　　要：目的总结体外循环(CPB)在序贯式双肺移植中应用经验。方法对4例终末期肺疾病患者行CPB下序贯式双肺移植手术。CPB选用Medtronic全肝素涂层抗血浆渗漏膜肺及肝素涂层管道、变温器、离心泵头,封闭式循环。维持ACT时间200～250s。CPB方式采用常温转流。结果4例患者中有3例顺利脱离CPB,转流时间为101～165min;1例因术后低氧和二氧化碳蓄积,应用体外膜式氧合器氧合(ECMO),历经67h,死于多脏器功能衰竭。结论转机时机、容量控制、流量调节和管路选用是CPB在双肺移植中成功关键。OBJECTIVE To summarize the clinical experience of cardiopulmonary bypass in bilateral sequential lung transplantation. METHODS 4 patients with end - stage lung disease underwent bilateral sequential lung transplantation in CPB. Heparin- bounded oxygenator,tubing and centrifugal pump, ACT were maintained between 200～250s. Stable hemodynamics and systemic oxygenation with normothermia were maintained throughout the operations. RESULTS 3 patients were survived. The durations of CPB were 101～ 165min. Another one was supported by ECMO for 67h into the postoperative period because of hypoxemia and hyperearbonics . This patient was died for multi - organ failure during ECMO. CONCLUSION The survival of bilateral sequential lung transplantation may be improved by active use of CPB support . The capacity and flow rate management are very important during CPB. It is necessary to use heparin - bounded extracorporeal system which decrease blood loss and transfusion requirement.

关 键 词：双肺移植 体外循环 ECMO 

分 类 号：R655.3[医药卫生—外科学]