老年患者心脏手术的体外循环管理  

Management of cardiopulmonary bypass in elderly patients underwent cardiac operation

作　　者：胡萍[1] 姜志斌[2] 许蓼梅[1] 何争鸣[1] 孙兰英[1] 段炼[1] 

机构地区：[1]中南大学公共卫生学院,湖南长沙410078 [2]中南大学湘雅三医院心胸外科,湖南长沙410011

出　　处：《中国现代医学杂志》2014年第9期65-68,共4页China Journal of Modern Medicine

基　　金：湖南省发改委资助项目[No:(2013)1199]

摘　　要：目的总结分析老年患者心脏手术的体外循环管理经验。方法回顾性分析我院73例65岁以上老年患者实施体外循环心脏直视手术的临床资料,全部患者体外循环过程中采用中度血液稀释、浅低温、高流量灌注,低温氧合血进行心肌保护,常规应用超滤。结果体外循环时间31～209 min（平均78.4 min）,阻断升主动脉时间21～103 min（平均45.7 min）,心脏自动复跳57例（78%）,术后1例患者死于低心排综合征。结论选择优质膜肺、适度稀释血液、采用高灌注流量、加强心肌保护、仔细做好术中监测、合理应用超滤,可为老年患者心脏手术成功提供重要保障。[ Objectives ] To summarize the experience of cardiopulmonary bypass（CPB） in elderly patients under- went cardiac operation. [Methods] We retrospectively analyzed the clinical data of 73 elderly patients underwent cardiac operation with CPB. During CPB, medium hemodilution, high flow, mild hypothermia, cold blood cardiople- gia and ultrafiltration technique were applied in each patient. [Results] The CPB time was 31-209 min （mean 78.4 min）. Aortic cross-clamp time was 21~103 min （mean 45.7 min）. One case died of low cardiac output syndrome. [ Conclusions ] High-quality membrane oxygenator, proper hemodilution, effective tissue perfusion, myocardial pro- tection, ultrafiltration technique and other comprehensive measures may help to improve and secure the cardiac oper- ation in elderly patients.

关 键 词：体外循环 老年患者 心肌保护 

分 类 号：R654.2[医药卫生—外科学]