常规体外循环与闭式体外循环相互转换在心脏手术中的管理  

Management of Common Cardiopulmonary Bypass and Closed Circulation Each Other Switched during Operation on Heart

作　　者：段大为[1] 李彤[1] 赵成秀[1] 张文芳[1] 胡晓旻[1] 吴鹏[1] 张强[1] 

机构地区：[1]天津市第三中心医院心脏中心,天津300170

出　　处：《中国体外循环杂志》2009年第4期226-228,共3页Chinese Journal of Extracorporeal Circulation

基　　金：天津市科委计划课题(06YFSZSF01500)

摘　　要：目的介绍用Medtronic ECMO套包改装成常规体外循环（CPB）管路与闭式体外循环（ECC）管路相互转换的管理方法及注意事项。方法15例重症心脏病患者,年龄6582（74±9.3）岁;采用Medtronic ECMO套包改装的常规CPB与闭式ECC管路。其中3例患者开胸前和心内操作完成后采用了闭式ECC;12例患者在心内操作完成后采用闭式ECC。结果15例患者采用闭式ECC时间31112（84±24.1）min,常规CPB时间5184（67±10.1）min。手术后呼吸机辅助时间414（8±2.9）h;24 h胸腔引流量110360（252±62.9）ml。15例患者没有出现血栓栓塞和气体栓塞并均顺利康复出院。结论应用Medtronic ECMO套包改装的常规CPB与闭式ECC相互转换管路临床应用方便、安全、有效,但要注意防止在旁路接头处形成血栓,防止转换过程中管道内进气。OBJECTIVE To introduce the method and of the Medtronic extracorporeal membrane oxygenation package was modified to common cardiopulmonary bypass（CPB） channel and closed circulation channel switched during operation on heart. METHODS 15 patients with severe heart disease,aged from 65 to 82（average 74±9.3） years old,were included.Medtronic extracorporeal membrane oxygenation package were modified to common CPB channel and closed circulation channel.Three patients were used closed circulation at before and after operation on heart,12 patients were used closed circulation after operation on heart.RESULTS For all patients,the common CPB time was 51-84（average 67±10.1）mins,closed circulation time was 31-112（average 84±24.1） mins.Mechanical ventilor assist time was 414（average 8±2.9）h;24h chest drainage was 110360（average 252±62.9）ml.All patients didn＇t appear thromboembolism and gas embolism and rehabilitation discharge successfully.CONCLUSION It is safe,convenient and feasible that Medtronic extracorporeal membrane oxygenator package is modified to common CPB and closed circulation channel for operation on heart,but must be pay attention to prevent thromboses at shunt adaptor and avoid the air getting into tubing during switching process.

关 键 词：体外循环 闭式体外循环 心脏手术 管理 

分 类 号：R654.2[医药卫生—外科学]