常规体外循环与闭式体外循环互换在心脏手术的应用  

The Application of Exchange Between Cardiopulmonary Bypass and Closed Extracorporeal Circulation 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：《中国胸心血管外科临床杂志》2009年第6期472-474,共3页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的介绍用体外膜式氧合(extracorporeal membrane oxygenation,ECMO)套包改装成常规体外循环管路与闭式体外循环相互转换管路在心脏手术中的应用方法和效果。方法2007年1月至2008年6月,我们采用Medtronic ECMO套包加装储血槽和动脉微栓过滤器改制成常规体外循环与闭式体外循环互换管路,通过股动脉-股静脉-上腔静脉插管或主动脉-右心耳插管,建立循环,对15例危重心脏病患者在心脏手术中进行体外循环支持及手术后的心功能支持。其中男10例,女5例;年龄65～82岁(74.0±9.3岁),体重63～89kg(69.0±11.4kg)。病种为陈旧性心肌梗死11例,急性心肌梗死1例,陈旧性心肌梗死合并二尖瓣狭窄和关闭不全1例,二次开胸行双瓣膜置换术2例。结果15例患者闭式循环时间为31～112min(77.3±21.5min),常规体外循环时间51～84min(69.7±9.8min);术后呼吸机辅助时间4～14h(8.3±2.9h);24h胸腔引流量110～360ml(227.3±80.4ml);均康复出院,心功能Ⅰ～Ⅱ级。随访13例,随访时间4～12个月,心功能均恢复良好,无并发症发生。结论应用该方法可为心脏手术患者开胸前、手术中及手术后提供有效的心肺支持,节约耗材成本;其肝素涂层可以减轻炎性反应,有利于患者康复。Objective To introduce the method and effect of common cardiopulmonary bypass（CPB） switched to closed extracorporeal circulation by medtronic extracorporeal membrane oxygenation（ECMO） package. Methods From Junuary 2007 to June 2008,common CPB switched to closed extracorporeal circulation by Medtronic ECMO package adding blood reservoir and artery microembolus filtrator was used to 15 patients with grave heart disease to provide CPB support during operation on heart and cardiac function support after operation. The circulation was built through femoral artery-femoral vein-superior vena cava intubation or aorta-right auricle intubation. There were 10 male and 5 female aged from 65-82 years （74.0±9.3 years） and weighed from 63-89 kg （69.0±11.4 kg）. There were 11 cases with old myocardial infarction,1 case with acute myocardial infarction,1 case with old myocardial infarction complicated with mitral stenosis and mitral incompetence,and 2 cases re-opened and undergone double valve replacement. Results For all the 15 patients,the closed circulation time was 31-112 min（77.3±21.5 min）. The CPB time was 51-84 min（69.7±9.8 min）. The postoperative mechanical ventilation time was 4-14 h（8.3±2.9 h）. The 24 h-chest drainage was 110-360 ml（227.3±80.4 ml）. All patients were cured and discharged successfully with cardiac function classification in grade Ⅰ-Ⅱ. Thirteen cases were followed up. The follow-up time was 4-12 months. Their cardiac function recovered well and no complication occurred. Conclusion This method could provide effective support for heart and lung before operation,during operation and after operation. This method could save material cost. The heparin paintcoat could reduce inflammatory reaction and it is good for patients＇ recovery.

关 键 词：体外循环 闭式体外循环 体外膜式氧合 心脏手术 

分 类 号：R654.2[医药卫生—外科学]