老年心脏瓣膜置换手术的体外循环管理经验  

The management of extracorporeal circulation during valve-replacement procedure in elder patients

作　　者：辛梅[1] 赵凯[2] 刘刚[1] 倪尔连 邬晓臣[1] 岳琴[1] 魏晓红[1] 欧阳辉[1] 张近宝[1] 

机构地区：[1]成都军区总医院心血管外科,成都610083 [2]成都军区总医院神经外科,成都610083

出　　处：《西南国防医药》2013年第10期1091-1093,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的总结探讨老年瓣膜心内直视手术的体外循环（ECC）管理经验。方法总结我院2011年1月-2012年12月142例老年瓣膜置换手术的ECC管理经验。全部采用浅低温、中度血液稀释、高流量ECC灌注，使用HTK液作为心肌保护液，经主动脉根部顺行或切开灌注。术中监测血气及电解质变化，所有患者术中均采用常规超滤和改良超滤技术。结果142例患者手术过程顺利，ECC时间136～211（145．7±27．6）min。主动脉阻断时间为89～133（96．3±7．3）min。术中心肌保护效果良好，未出现心电活动，均顺利脱机。术后死亡2例，死亡原因均与ECC无关。结论对于老年心脏瓣膜置换手术，采用合适的ECC方法，重视各脏器的保护，可有效地提高手术的成功率，对患者术后转归起着关键性的作用。Objective To explore the management of extracorporeal circulation(ECC) during valve-replacement surgery in elder patients.Method The clinical data of the ECC management of 142 senile patients was analyzed.All of them undergone mild hypothermic,hemodilution,high flow and regular or modified ultrafiltration.HTK solution used for the myocardial preservation was transfused through aortic root.The changes of their blood gas analysis and electrolytes were monitored during the operation.Results All surgical operation went smoothly and the ECC time was 136-211(145.7±27.6) min,the aorta-block time was 89-133(96.3±7.3) min.The result of the myocardial preservation was good and no electrocardiological activities were recorded.Two cases died whose death causes were not related with ECC.Conclusion During the surgery procedure of valve-replacement surgery in elder patients,the suitable ECC should be selected and more attention should be paid to organ-preservation,which can increase the successful rate and play a key role in the prognosis.

关 键 词：老年 瓣膜置换 体外循环 管理 

分 类 号：R654.1[医药卫生—外科学]