再次及多次心脏瓣膜置换术体外循环插管路径选择策略分析  

Cannulation strategies for extracorporeal circulation during redo heart valve re⁃placement surgery

作　　者：孔博[1] 杨研[1] 孙寒松[1] 杨克明[1] Kong Bo;Yang Yan;Sun Hansong;Yang Keming(Department of Adult Cardiovascular Surgery,Fuwai Hospital,National Center of Cardiovascular Disease,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院成人外科中心,北京100037

出　　处：《中国体外循环杂志》2020年第6期350-354,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的总结不同瓣位再次(或多次)瓣膜置换体外循环插管路径的选择策略。方法2014年1月至2019年7月,本中心接受再次或多次心脏瓣膜置换者552例,其中男性247例,女性305例,年龄0.8~79(45.5±3.0)岁,体重7.9~102(59.5±10.6)kg,根据再次瓣膜置换的瓣位将患者分为7组:二尖瓣置换(MVR)组231例、主动脉瓣置换(AVR)组143例、三尖瓣置换(TVR)组36例、肺动脉瓣置换(PVR)组58例、联合瓣膜置换(BVR)组57例、合并主动脉置换(AOR)组24例、单心室共同房室瓣置换组3例。动脉插管路径包括:①升主动脉;②股动脉;③股动脉+升主动脉;静脉插管路径包括:①腔静脉;②股静脉;③上腔静脉+股静脉;④颈内静脉+股静脉。结果①动脉插管方式:升主动脉插管458例(83.0%);股动脉插管61例(11.0%);股动脉联合升主动脉插管33例(6.0%)。②静脉插管方式:腔静脉插管508例(92.2%);股静脉插管11例(2.0%);股静脉+上腔静脉插管32例(5.6%);股静脉+颈内静脉插管1例(0.2%)。PVR组采用股动脉+升主动脉插管以及合并主动脉置换组采用股动脉插管的比例均显著高于其他各组(P=0.000),PVR组较其他各组采用股静脉+上腔静脉插管方式的患者比例更高(P<0.05)。结论“升主动脉-腔静脉”插管策略适用于绝大多数的MVR、AVR、TVR、BVR以及共同房室瓣再次(或多次)置换者;“股动脉+升主动脉-股静脉+上腔静脉”策略在PVR者应用较多;“股动脉-腔静脉”策略主要应用于合并主动脉置换的患者。Objective To summarize the cannulation strategies for redo(or multiple)valve replacement surgery under extra⁃corporeal circulation.Methods From January 2014 to July 2019,552 patients underwent redo(or multiple)heart valve replacement surgery in our center,including 247 males and 305 females,aged 0.8-79(45.5±3.0)years old and weighted 7.9-102(59.5±10.6)kg.They were divided into seven groups according to the specific valve position of the redo-valve replacement:mitral valve replacement(MVR)group(n=231),aortic valve replacement(AVR)group(n=143),tricuspid valve replacement(TVR)group(n=36),pulmonary valve replacement(PVR)group(n=58),combined valve replacement(BVR)group(n=57),combined aortic replace⁃ment(AOR)group(n=24),and single ventricular common atrioventricular valve replacement group(n=3).Arterial cannulation pathways included:1.ascending aorta,2.femoral artery,3.femoral artery+ascending aorta.Venous cannulation pathways included:1.vena cava,2.femoral vein,3.superior vena cava+femoral vein,4.Internal jugular vein+femoral vein.Results Cannulation strat⁃egies for extracorporeal circulation:1.Arterial cannulation pathways:458 cases(83.0%)of ascending aorta;61 cases(11.0%)of femoral artery;and 33 cases of combined femoral artery and ascending aorta cannulation(6.0%).2.Venous cannulation pathways:508 cases(92.2%)of vena cava cannulation;11 cases(2.0%)of femoral vein cannulation alone;32 cases(5.6%)of femoral vein+superior vena cava cannulation;1 case(0.2%)of femoral vein+internal jugular vein cannulation.The proportions of femoral artery+ascending aorta cannulation in the PVR group and femoral artery cannulation in the combined aortic replacement group were significant⁃ly higher than those of other groups(P=0.000).Moreover,the PVR group adopted a higher proportion of femoral vein+superior ve⁃na cava cannulation strategy than other groups(P<0.05).Conclusion The"Ascending aorta--vena cava"cannulation strategy is suitable for most redo(or multiple)MVR,AVR,BVR,TVR and common atrioventricular valves replacement

关 键 词：再次瓣膜替换 体外循环 插管 路径选择 

分 类 号：R654.2[医药卫生—外科学]