急诊心脏手术中止血困难的原因分析及处理对策  

Cause Analysis and Treatment Strategies for Difficult Hemostasis in Emergency Cardiac Surgery

作　　者：万静雯[1] 吴波[1] 徐利军[2] 

机构地区：[1]华中科技大学同济医学院附属同济医院手术室,武汉430030 [2]华中科技大学同济医学院附属同济医院心胸外科,武汉430030

出　　处：《临床误诊误治》2015年第9期56-58,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨急诊心脏手术中止血困难的主要原因以及针对性处理对策。方法选择我院2010年9月—2014年9月术中止血时间≥2 h或止血过程中出血量>300 ml等术中止血困难的急诊心脏手术患者41例,探讨术中止血困难可能的原因及相应处理措施的效果。结果本组21例De BakeyⅠ型主动脉夹层行Sun's术术中止血困难,其中7例为吻合口出血(5例予加固缝合、输血液制品等综合措施后出血控制,2例采取各种措施仍无法止血者以纱布填塞延期处理),14例术野广泛渗血采取综合措施后出血控制。17例行急诊冠脉搭桥者术中术野广泛渗血,采取综合措施后出血控制。3例心脏移植者因吻合口出血、术野广泛渗血致术中止血困难,经加固缝合等综合措施后出血控制。术后无因出血而再次手术者,2例死亡(1例行SUN's手术者发生多器官功能衰竭,1例行急诊冠脉搭桥者发生低心排出量综合征)。结论术前一般情况差、术前抗凝、体外循环、疾病因素为急诊心脏手术术中止血困难的主要原因,采取缝合、纠正凝血状态并其他措施为补充的综合措施可收到较好的效果。Objective To examine the risk factors for difficult hemostasis in emergency cardiac surgery and evaluate the treatment strategy. Methods 41 cases were selected from 85 patients undergoing emergency cardiac operation during September 2010 and September 2014 in our hospital. It was considered as difficult hemostasis that if total time for hemostasis was over 2 h or 300 ml of blood loss during this period. Data was collected from the selected patients, risk factors related to difficult hemosta-sis in emergency cardiac surgery were indentified and effects of different measures for hemostases were evaluated. Results 21 cases undergoing Sun＆#39;s operation for Aortic Dissection （ Debakery typeⅠ） , had difficult hemostasis, 7 cases were stoma hemosta-sis, among which, 5 cases with suture and blood transfusion comprehensive measures, the hemostasis was controlled;2 cases as-lo had difficult hemostasis with all measures tried, but fail to control the hemostasis, therefore gauze packing was used to deter hemostasis;14 cases of Debakery typeⅠand 17 cases of emergency coronary artery bypass and 3 cases of heart transplantation ex-perienced difficult hemostasis （major causes were leakage of anastomosis and angiostaxis of wound surface）. All treatments of various measures for hemostasis （ eg. enhanced suture and multi-coagulant substance） were effective and only 2 patients died af-ter operation （1 patient undergoing Sun＆#39;s operation died of multiple organ failure, another undergoing emergency coronary artery bypass died of low cardiac output syndrome）. Conclusion Extracorporeal circulation, pathology and physiology of diseases, poor physical condition and preoperative anticoagulant usage are specific high risk factors of difficult hemostasis in emergency cardiac surgery, and multiple-treatments based on analysis of possible causes are effective to control difficult hemostasis.

关 键 词：止血困难 危险因素 急诊处理 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]