28例全胸腔镜心脏手术的体外循环管理体会  

Experience of Extracorporeal Circulation Management of 28 Cases with Totally Thoracoscopic Cardiac Surgery

作　　者：朱雪双 张大发[1] 聂军[1] 钱红波[1] 韦俊[1] 杨敏[1] 汤天生[1] 

机构地区：[1]皖南医学院弋矶山医院心血管外科,安徽芜湖241000

出　　处：《系统医学》2017年第8期60-63,共4页Systems Medicine

摘　　要：目的评价全胸腔镜心脏手术的体外循环临床应用效果,总结该院全胸腔镜心脏手术体外循环管理的初步经验。方法选取该院2012年7月—2016年12月行全胸腔镜心脏外科手术患者28例作为观察组,选取同期行传统开胸心脏手术患者24例作为对照组,观察两组体外循环时间、心脏阻断时间、常规超滤量以及术后重症监护室停留时间、住院时间。结果术后两组患者均康复出院,无围手术期死亡病例。观察组平均体外循环时间(86.1±25.2)min,平均心脏阻断时间(47.6±13.9)min,术中常规超滤量(987.5±125.5)m L,重症监护室停留时间(24.7±16.9)h,术后住院时间(7.1±1.2)d,均少于对照组,差异有统计学意义(P<0.05)。结论股动静脉插管建立体外循环安全可行,必要时联合应用负压辅助静脉引流技术(VAVD)及加用上腔插管或颈内静脉插管等方法,为术中体循环的充分灌注提供了安全保证。体外循环管理方面应重视灌注师、麻醉师及手术医师的交流及配合。Object ive To evaluate the cl inical application effect of extracorporeal circulation in the totally thoracoscop-ic cardiac surgery and summarize the initial experience of it. Methods 28 cases of patients with totally thoracoscopic cardiac surgery in our hospital from July 2012 to December 2016 were selected as the observation group, 24 cases of patients with traditional open cardiac surgery at the same period were selected as the control group, and the extracorpo-real circulation time, cardiac blocking time, routine ultrafiltration volume, postoperative ICU duration and length of stay of the two groups were observed. Results After operation, both groups were discharged after recovery, and there were no death cases during the perioperative period, and the average extracorporeal circulation time, average cardiac blocking time, routine intraoperative ultrafiltration volume, ICU duration and postoperative length of stay were fewer than those in the control group （86.1±25.2）min,（47.6±13.9）min,（987.5±125.5）mL,（24.7±16.9）h,（7.1±1.2）d, and the differences were statistically significant （P 〈 0 .0 5 ） . C on c lu s ion The establishment of extracorporeal circulation by the arteriovenous catheterization is safe and feasible, if necessary, the combined application of VAVD and epicoele intubation tube or in-ternal jugular vein cannulation can provide guarantee for the full perfusion of intraoperative general circulation, and we should pay attention to the communication and cooperation of perfusionists, anesthetists and operation physicians in the extracorporeal circulation management.

关 键 词：全胸腔镜 心脏手术 体外循环 

分 类 号：R654.2[医药卫生—外科学]