70岁以上患者行心血管外科手术的体外循环管理  

The management of cardiopulmonary bypass in the patients over 70 years during open heart surgery

作　　者：刘晋萍[1] 周庆玲[2] 龙村[1] 

机构地区：[1]中国医学科学院阜外心血管病医院体外循环科,北京市100037 [2]山东医科大学第二附属医院心脏外科

出　　处：《中华老年医学杂志》2001年第3期186-188,共3页Chinese Journal of Geriatrics

摘　　要：目的　总结 70岁以上患者行心血管外科手术体外循环管理的经验。　方法　回顾性分析 84例 70岁以上老年患者行心脏直视手术前的一般状况和术中体外循环管理方法 ,并随机选取同期 80例 40～ 6 0岁非老年冠状动脉搭桥手术患者 ,通过对比两组患者术前状况和术中管理方法 ,总结针对老年患者的发病特点所应采取的行之有效的管理措施。　结果　老年患者术前易合并高血压、糖尿病、慢性肾功能衰竭、肺功能异常等疾病 ,术中平均体外循环时间 (115 6± 2 7 0 )min ,升主动脉阻断时间 (80 4± 32 2 )min ,最低鼻温 (2 9 8± 1 4)℃ ,最低肛温 (30 7± 0 8)℃ ,与非老年组比较差异无显著性 ;用库血预充 71例 ,占 85 3% ,明显高于非老年组患者 (2 1例 ,P <0 0 5 ) ,老年组患者停机时红细胞压积比 (HCT) (2 5 8± 3 0 ) % ,而非老年组患者停机时维持HCT(2 3 4± 1 6 ) % ,两组间差异有显著性 (P <0 0 1)。老年组患者术中平均动脉压维持 6 0～ 90mmHg ,81例患者顺利脱离体外循环机 ,3例患者因左心功能差停机困难 ,采用主动脉内球囊反搏 (IABP)辅助 ,预后良好。　结论　高龄并非心脏手术体外循环的禁忌证 ,根据其患病特点 ,合理地行体外循环管理 ,可以为老年患者成功地进行心血管外科手术提供重要保证。Objective To summarize the effective managements of cardiopulmonary bypass (CPB) duing open heart surgery in the elderly patients by comparing with that of the non-elderly groups. Methods Pre-operative common data and the managements for 84 elderly patients during the cardiopulmonary bypass from January 1998 to June 2000 were analyzed retrospectively, and the same data of 80 non-elderly patients(40-60 years old) who underwent CABG during the same period were also randomly selected and compared. Results The elderly patients were usually combined with hypertension, diabeties, chronic kindney failure and abnormal pulmonary function. The average time for CPB and clamping time for the ascending aorta were (115.6±27.0)min and (80.4±32.2)min, respectively. The average lowest nasopharyngeal and anal temperature was (29.8±1.4)℃ and (30.7±0.8)℃, respectively, showing no significant difference comaparing with those of the non-elderly patients. There was significant difference between the two groups in the transfusion of shed blood(P<0.05). The hematocrit (HCT) at the end of CPB was maintained at(25.8±3.0)% for the elderly and at (23.4±1.6)% for the non-elderly (P<0.01). The mean artery pressure (MAP) for the elderly patients was at 60-90 mm Hg. Eighty-one elderly patients were smoothly weaned from CPB, and only 3 were recovered in the aid of IABP and with good prognosis. Conclusions The age could not be a contraindication for CPB. Effective and reasonable managements according to the individual characters would be more important for the success of cardiovascular surgery.

关 键 词：体外循环 心脏外科手术 手术方法 

分 类 号：R654[医药卫生—外科学] R614[医药卫生—临床医学]