微创机器人辅助下心脏手术中体外循环的各种引流方法比较  

The Comparison of Various Drainage Methods in Minimally Invasive Robotic Assisted Heart Surgery under Cardiopulmonary Bypass

作　　者：赵赟[1] 程玥[1] 胡克俭[1] 魏来[1] 沈金强[1] 王春生[1] 

机构地区：[1]复旦大学附属中山医院心脏外科,上海200032

出　　处：《生物医学工程学进展》2014年第2期78-80,83,共4页Progress in Biomedical Engineering

基　　金：上海市重点学科建设项目资助(B116)

摘　　要：目的分析比较机器人系统辅助下微创心脏手术中体外循环的各种静脉引流方式和辅助引流方法的特点和管理。方法 24例患者接受体外循环下微创机器人辅助(Da vinci S)心脏手术,股动静脉插管建立体外循环,不同的辅助引流方法分三组,D1组离心泵辅助引流12例,D2组负压辅助引流7例,D3组颈内静脉插管辅助引流5例。结果三组间平均静脉引流量和平均每公斤静脉引流量基本相似,无统计学差异。三组术中转流基本平稳,血流动力学相对稳定,各项监测指标均在正常范围,手术视野暴露清晰满意,全组的平均体外循环时间为139.7±35.5min,平均主动脉阻断时间为84.2±28.8min。结论在股静脉引流的基础上,根据不同的手术方式和手术医生的要求,灌注师应用不同的辅助引流方式并制定不同的灌注对策,用于保证转流过程中充分的引流和灌注,是机器人辅助微创心脏手术顺利、成功的重要因素之一。Objective To compare and analyze the characteristics and management of different methods of venous drainage and auxiliary drainage during robotic assisted on -pump minimally invasive cardiac surgery. Methods 24 cases of patients underwent on-pump cardiac surgical procedures with peripheral extracorporeal cir-culation established by cannula of femoral arterial and vein using Da Vinci S surgical system. The auxiliary drainage methods were divided into 3 groups,centrifugal pump auxiliary drainage（D1 group,n=12）,vacuum-assisted drainage（D2 group,n=7）,and internal jugular vein cannula auxiliary drainage（D3 group,n=5）. Result The average venous drainage and the average venous drainage per kilogram were similar in three groups without sta-tistical difference. Steady transit operation flow,stable hemodynamics,normal monitoring indicators and acceptable surgical field exposure were observed during pump cardiac surgery of three groups . The mean peripheral extracor-poreal and aortic cross-clamping time were 139. 7 ± 35. 5mins and 84. 2 ± 28. 8mins,respectively. Conclusion On the basis of femoral venous drainage,perfusionists should apply different drainage methods and make cor-responding strategies,according to different surgical procedures and surgeons to ensure adequate and sufficient drainage and perfusion. This is one of the most important factors of successful robotic assisted on-pump cardi-ac surgeries.

关 键 词：体外循环 静脉引流 机器人辅助系统 心脏外科 

分 类 号：R654.2[医药卫生—外科学]