开辟绿色通道救治动脉瘤患者的体外循环应对策略  

Strategy of cardiopulmonary bypass for aortic aneurysm surgery in 37 cases underwent the green channel emergency operation

作　　者：陈祥舟[1] 刘梅[1] 肖颖彬[1] 王学锋[1] 陈林[1] 李福平[1] 郝嘉[1] 

机构地区：[1]第三军医大学附属新桥医院全军心血管外科研究所,重庆400037

出　　处：《中国体外循环杂志》2013年第2期96-100,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的探讨开辟绿色通道救治动脉瘤患者的体外循环(CPB)应对策略,以及术中重要脏器的保护方法。方法回顾性分析本院从2010年1月至2012年3月开辟绿色通道救治的37例动脉瘤患者;其中Stanford A型主动脉夹层29例,升主动脉瘤3例,马凡综合征5例;行升主动脉替换9例(合并冠状动脉旁路移植1例),升主动脉+主动脉半弓替换3例,升主动脉替换+术中支架植入11例,Bentall术10例,Bentall术+术中支架植入术4例。CPB采用右侧股动脉插管6例,右侧腋动脉插管22例,右侧股动脉及右侧腋动脉插管的单泵双管灌注9例;采用中度低温19例,深低温停循环(DHCA)及上腔静脉逆行灌注(RCP)4例,DHCA及选择性脑顺行灌注(SACP)14例;常规使用自体血液回收系统(ICS)。结果本组病例CPB时间164～343(222.1±30.2)min;主动脉阻断时间47～215(119.7±29.1)min;DHCA时间3～49(24.5±11.3)min;术中或术毕进行超滤31例,滤出液体250～4 300(2396.3±829.1)ml;ICS洗涤红细胞176～1 645(647.4±209.1)ml。术后清醒时间8～76(32.7±14.3)h,术后死亡4例,包括多器官功能衰竭3例,心跳骤停1例;其余患者均康复出院,无神经系统功能障碍及与CPB相关并发症。结论根据手术部位和方法,选择相应的插管位置及CPB方法是绿色通道动脉瘤患者手术成功的基础,加强术中CPB管理及重要脏器保护是减少术后并发症的关键。Objective To explore the strategy of cardiopulmonary bypass （CPB） for aortic aneurysm surgery patients under- went the green channel emergency operation and methods of the important organs protection during CPB. Methods The clinical mate- rials and management of CPB were retrospectively analyzed for 37 cases underwent the green channel emergency operation with aortic aneurysm form Jan. 2010 to Mar. 2012, which included Stanford type A aortic dissection in 29 cases, ascending aorta aneurysm in 3 cases and Marfan~ syndrome in 5 cases. The operation procedure included ascending aorta replacement in 9 cases combined with coro- nary artery bypass grafting （CABG） in 1 case, ascending aorta replacement and semi arch replacement in 3 cases, ascending aorta re- placement and endovascular stent in 11 cases, Bentall procedure in 10 cases, Bentall procedure and endovascular stem in 4 cases. The perfusion methods included right femoral artery cannulation in 6 cases, right axillary artery cannulation in 22 cases, the double arterial lines （right femoral artery cannulation and right axillary artery cannulaton） with single pump head perfusion in 9 cases; and moderate hypothermia CPB in 19 cases, deep hypothermic circulation arrest （DHCA） combined with retrograde cerebral perfusion （RCP） form superior vena cava in 4 cases, DHCA combined with selective antegrade cerebral perfusion （SACP） in 14 cases. Intra - operative cell salvage （ICS） system was used in all 37 cases. Results The time of CPB, aortic cross -clamping and DHCA were 164 -343 （222.1±30.2） min, 47 -215 （ 119.7±29.1 ） min and 3 -49 （24.5±11.3） min. The ultrafiltration was used in 31 cases during or at the end of CPB and filter fluid was 250 - 4300 （2396.3 ± 829.1 ） ml, the ICS washed red blood cell was 176 - 1645 （ 647.4±209.1 ） ml. 37 cases recovered after operation in 8 - 76 （32.7±14.3 ） h. 4 cases died postoperatively including 3 cases of mul- tiple organs failure and 1 case of heart arrest, while others recov

关 键 词：绿色通道 动脉瘤 体外循环 脏器保护 

分 类 号：R654.3[医药卫生—外科学]