大血管手术中的体外循环管理  

Management of extracorporeal circulation during operation's on large artery

作　　者：程光存 严中亚 吴一军 雷虹 孙云 卢中 郑理 朱正艳 汤丹丹 姜波 

机构地区：[1]安徽医科大学附属省立医院安徽省心血管病研究所心脏外科,230001

出　　处：《心肺血管病杂志》2011年第4期319-322,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：安徽省卫生厅科研计划课题(09A006)

摘　　要：目的:总结各种大血管手术中的体外循环(extracorporeal circulation,ECC)方法及管理经验。方法:体外循环下完成各种大血管手术21例,升主动脉人造血管置换、Bentall手术、全主动脉弓置换(象鼻术)+带膜支架植入手术,21例患者采用改良心肌保护液灌注,均用深低温停循环+顺行性脑灌注方法或逆行灌注方法。结果:21例主动脉夹层患者进行手术治疗,其中7例行Bentall手术,3例行升主动脉置换术+主动脉瓣成形手术+全弓置换术+象鼻手术,1例行升主动脉置换术,10例行Bentall手术+全弓置换术+象鼻手术,采用深低温停循环(DHCA)加选择性脑灌注手术治疗主动脉夹层21例。本组ECC时间129～414(182.3±51.9)min,主动脉阻断时间83～258 min,平均(132.3±52.8)min。深低温停循环时间8～53 min,平均(29.10±18.30)min,选择性脑灌注时间8～58 min,平均(33.4±18.5)min。停循环最低鼻咽温13.8～20.1(17.8±3.5)℃,转流中尿量450～4 900(2 326.1±1 061.2)mL,超滤量1 000～5 000(2 783.9±1 246.6)mL,术后呼吸机辅助时间11～192(37.8±22.3)h,术后24 h胸腔引流量120～1 850(523.2±353.1)mL。无手术死亡,无术后低心排出量综合征(低心排)和多脏器功能衰竭,均治愈出院,无永久性脑损害发生。21例患者中,均痊愈出院。结论:针对不同的大血管手术选择不同的ECC方法并加强围术期ECC管理,可以显著减少并发症,提高手术的成功率。Objective：To summarize the various major vascular surgery in cardiopulmonary bypass（extracorporeal circulation,ECC） methods and management experience.Methods：21 cases including all kinds of large vessels were completed under cardiopulmonary bypass surgery,aortic artificial vascular replacement,Bentall surgery,total aortic arch replacement（elephant trunk technique） with stent implantation,21 patients with modified myocardial preservation perfusion,were deep hypothermic circulatory arrest with antegrade cerebral perfusion or retrograde perfusion method.Results：21 surgical treatment patients with aortic dissection,of which 7 cases were Bentall procedure,3 cases ascending aorta replacement with aortic valve plasty and full aortic replacement surgery plus elephant trunk technique,1 case replacement of ascending aorta,10 cases Bentall procedure and full aortic replacement surgery plus elephant trunk technique with deep hypothermic circulatory arrest（DHCA） plus selective cerebral perfusion in 21 cases of aortic dissection surgery.ECC time was 129~414（182.3±51.9） min in this group,the main artery occlusion time was 83~258 min,the average was（132.3±52.8） min.Deep hypothermic circulatory arrest time was 8~53 min,the average was（29.10±18.30） min,selective cerebral perfusion time was 8~58 min,the average was（33.4±18.5） min.Lowest nasopharyngeal temperature was 13.8~20.1（17.8±3.5） ℃ during circulatory arrest,and bypass urine output was 450~4 900（2 326.1±1 061.2） mL,ultrafiltration volume was 1 000~5 000（2 783.9±1 246.6） mL,postoperative ventilation time was 11~192（37.8±22.3） h,chest drainage at operation 24 h after was 120~1 850（523.2±353.1） mL.There was no operative death,postoperative low cardiac output and multiple organ failure,and discharged without permanent brain damage occurred.21 patients were cured.Conclusion：Different major vascular surgery choose a different ECC methods and strengthen the management of perioperative ECC can significantly reduce com

关 键 词：体外循环 大血管手术 深低温停循环 选择性脑灌注 心脏疾病 

分 类 号：R543[医药卫生—心血管疾病]