成年人小左心室体外循环心脏手术41例治疗体会  

Adults with small left ventricle cardiac operation with cardiopulmonary bypass treatment experience of 41 cases

作　　者：母存富 张文林[1] 杨晋平[1] 张熠[1] 向家勇[1] 程涵[1] 

机构地区：[1]四川省广元市第一人民医院胸心外科,四川广元628017

出　　处：《湖南中医药大学学报》2012年第2期31-32,36,共3页Journal of Hunan University of Chinese Medicine

摘　　要：目的总结成年人小左心室体外循环手术围术期的治疗方法及经验。方法 41例成年人小左心室病例,包括先天性心脏病27例,风湿性心脏病13例,Lutembacher综合征1例,左心室舒张期末内径(LVEDD)32～40 mm,平均36.5 mm,均接受体外循环手术治疗。结果本组术后均使用多巴胺,部分加用多巴酚丁胺、肾上腺素,术后应用呋塞米等药物利尿、地高辛等治疗。术后1例ASD发生脑栓塞,2例ASD病人发生低心排血综合征(LCOS),其中1例致二尖瓣中度关闭不全,1例风心病二尖瓣狭窄发生顽固性室速、室颤,其余病例均心功能Ⅱ级出院。全组病例无死亡。结论对于成年人小左心室患者,正确的术中决策及在围术期积极使用正性肌力药物增强心肌收缩力、应用扩血管药物及利尿剂减轻心脏负荷,是治疗成功的关键。Objective To summarize adults small left ventricular extracorporeal circulation operation perioperative treatment method and experience.Methods 41 cases of adults with small left ventricle patients,including 27 cases of congenital heart disease,rheumatic heart disease 13 cases,Lutembacher Syndrome 1 case,left ventricular end diastolic diameter（LVEDD） 32～40mm,the average 36.5mm,underwent extracorporeal circulation operation treatment.Results The postoperative use of dopamine,and some plus dobutamine,some epinephrine,postoperative application of furosemide diuretics,digoxin therapy drugs.After operation in 1 cases of cerebral embolism in 2 cases of ASD,ASD occurred in patients with low cardiac blood syndrome（LCOS）,including 1 cases of mitral regurgitation caused by moderate,1 case with rheumatic mitral stenosis occurring intractable ventricular tachycardia,ventricular fibrillation,the rest cases were cardiac function grade II discharge.All of the cases without mortality.Conclusion For adults with small left ventricle patients,correct intraoperative decision making and in perioperative period of active use of inotropic agents increase myocardial contractility,application of vasodilators and diuretics attenuate cardiac load,is the key to successful treatment.

关 键 词：小左心室 体外循环 围术期 心脏外科手术 

分 类 号：R654.1[医药卫生—外科学] R654.2[医药卫生—临床医学]