右心房内引流术在主动脉根部置换中的应用  

Application 0f creating a internal drainage to right atrial on aortic root replacement operation

作　　者：何维来[1] 周汝元[1] 葛圣林[1] 张士兵[1] 李峰[1] 张成鑫[1] 冯俊波[1] 车轰[1] 

机构地区：[1]安徽医科大学第一附属医院心脏外科,合肥230022

出　　处：《安徽医学》2012年第2期191-193,共3页Anhui Medical Journal

摘　　要：目的探讨有效控制主动脉根部置换术中局部出血的有效方法。方法对行主动脉根部置换术的患者,采用瘤体血管片或自体心包片缝合包裹人造血管及吻合口,并与右心房房顶、右心耳部行吻合,建立与右心房间的交通,将人造血管及各吻合口渗血引流入右心房内。结果 7例主动脉根部置换手术患者中无需要再次开胸止血,出院前心脏超声检查局部均未发现左向右分流。患者停体外循环后平均止血关胸时间大为缩短[(47.65±33.45)min],术中出血量及术后24 h引流量显著减少[(187.26±83.82)ml],术后心律失常等并发症发生率无明显变化。结论主动脉根部置换手术中,控制人造血管各吻合口局部渗血是个难题,采用瘤囊壁或自体心包片缝合包裹人工血管形成腔隙,与右心房内引流方法是控制出血的有效方法,可避免大量失血及长时间止血带来的严重的并发症甚至死亡。Objective To explore a modus operandi in creating a chamber around the artificial blood vessel to right atrial to control the uncontrollable bleeding during aortic root replacement operation.Methods A chamber around the aortic graft was created by suturing tumor cystis piece or a patch of autologous pericardium,and then the chamber was communicated with the right atrial to drain capillary hemorrhage from the root stoma.Results None of these patients required re-expbrasion for bleeding and they were discharged from the hospital without arrhythmia or other complications.All 7 patients underwent echocardiogaph examination before discharge and no perigraft to right atrial shunt was detected.The time of stoping bleeding and closing chest was largely shortened（47.65±33.45min） and volume of bleeding during operation and the first 24h drainage（187.26±83.82ml） was significantly decreased.Conclusion Internal drainage to right atrial is a effective mean to control bleeding and avoid the happens of severe complications and even death during the aortic root replacement operation.

关 键 词：主动脉根部置换 心房内引流 心脏外科 体外循环 

分 类 号：R654.2[医药卫生—外科学]