白塞氏病累及主动脉瓣患者再次手术的心肺转流体会  

Experience of cardiopulmonary bypass during the reoperation with Behcet's dis⁃ease involving the aortic valve

作　　者：侯艳婷 李虔桢[1] 吕晓钗[1] 杜剑之[1] 王蕾 林勇[1] 陈良万[1] Hou Yanting;Li Qianzhen;Lv Xiaochai;Du Jianzhi;Wang Lei;Lin Yong;Chen Liangwan(Department of Cardiac Surgery,Union Hospital,Fujian Medical University,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院心血管外科,福州350001

出　　处：《中国体外循环杂志》2020年第5期292-294,共3页Chinese Journal of Extracorporeal Circulation

摘　　要：目的总结白塞氏病累及主动脉瓣患者行再次外科治疗的心肺转流(CPB)管理体会。方法2014年7月至2018年12月,7例免疫抑制剂及激素治疗的白塞氏病累及主动脉瓣患者,因严重主动脉瓣关闭不全、瓣周漏及机械瓣撕脱需在CPB下再次手术治疗,术中采用浅低温下CPB,应用合适的插管及药物,术中加强心肌保护、血液保护,及时超滤的管理方法。结果总CPB时间(166.78±54.60)min,主动脉阻断时间(84.22±29.18)min,心脏自动复跳4例,余3例经电除颤后全部恢复自主心跳,全部患者转流过程顺利。术后1例患者发生低心排综合征死亡(死亡率14.3%),其余患者恢复良好,顺利出院。结论白塞氏病累及主动脉瓣手术患者发生瓣周漏概率高,需再次手术机率大,手术风险高,应用合适的CPB管理为手术提供重要保障。Objective To summarize the experience of cardiopulmonary bypass(CPB)management during the reoperation on patients with Behcet's disease involving the aortic valve.Methods From July 2014 to December 2018,7 cases of Behcet's disease in⁃volving the aortic valve treated with immunosuppressant and hormone received reoperation due to severe aortic regurgitation,paravalvu⁃lar leaks and mechanical valve avulsion.The management measures of mild hypothermia,appropriate cannulation and medicine,en⁃hanced myocardial protection and blood protection,as well as timely ultrafiltration were administrated during the operation.Results Total CPB time was(166.78±54.60)minutes,aortic cross clamp time was(84.22±29.18)minutes.Four patients recovered automati⁃cally and the rest of three patients recovered after defibrillation.All patients were smoothly weaned from CPB smoothly.One patient died of low cardiac output after operation(mortality 14.3%),the rest recovered well and discharged uneventfully.Conclusion Behcet's disease involving the aortic valve is associated with a higher incidence of paravalvular leakage,a higher chance of reoperation,and a higher risk of surgery.Appropriate management of CPB can provide an important guarantee for a successful operation.

关 键 词：白塞氏病 主动脉瓣 再次手术 心肺转流 心肌保护 血液保护 

分 类 号：R654.2[医药卫生—外科学]