深低温停循环技术在肺动脉血栓内膜剥脱手术中的应用  

Application of deep hypothermic circulatory arrest in pulmonary thromboendarterectomy

作　　者：刘晓鹏 甄雅南[1] 孙光[1] 张亚军[2] 方颖慧 刘鹏[1] LIU Xiaopeng;ZHEN Ya'nan;SUN Guang;ZHANG Yajun;FANG Yinghui;LIU Peng(Department of Cardiovascular Surgery,China-Japan Friendship Hospital,Beijing 100029,China;Department of Surgical Anesthesia,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]中日友好医院心脏血管外科,北京100029 [2]中日友好医院手术麻醉科,北京100029

出　　处：《中国医药科学》2021年第15期35-38,共4页China Medicine And Pharmacy

摘　　要：目的总结深低温停循环技术在肺动脉内膜剥脱手术中的应用经验。方法回顾分析2018年12月至2020年12月中日友好医院60例肺动脉内膜剥脱手术患者资料,手术均在深低温停循环下完成。体外循环过程中采用精确温度控制,缓慢、均匀降温及复温;同时采用严格的脏器保护措施。统计围术期体外循环相关脑损伤及肾损伤事件,并对相关的因素进行分析。结果60例患者均顺利完成手术,术中停循环总时间为(58.7±17.6)min。术后17例患者出现肾功能损伤,其中3例出现急性肾功能衰竭并行透析治疗,后肾功能逐渐恢复。14例患者出现脑损伤表现,其中9例表现为一过性情绪障碍,5例出现功能性神经损伤症状,但均为可逆性。单因素分析显示脑氧饱和度(rSO_(2))<40%持续时间及rSO_(2)最大下降率与脑损伤显著相关。多因素分析显示仅rSO_(2)<40%持续时间与脑损伤相关。此外多因素分析显示停循环总时间与肾功能损伤及围术期感染显著相关。结论深低温停循环技术是肺动脉内膜剥脱手术成功的关键,在严格的脏器保护措施下深低温停循环技术是安全的。Objective To summarize the application experience of deep hypothermic circulatory arrest in pulmonary thromboendarterectomy.Methods The data of 60 patients undergoing pulmonary thromboendarterectomy in China-Japan Friendship Hospital from December 2018 to December 2020 were retrospectively analyzed.The operations performed on all patients were all completed under deep hypothermic circulatory arrest.Precise temperature control,slow and uniform cooling and rewarming were used during extracorporeal circulation,and scrupulous organ protection measures were also adopted.The events of brain injury and kidney injury related to extracorporeal circulation in the perioperative period were counted,and the related factors were analyzed.Results All 60 patients underwent operations successfully,and the total duration of intraoperative circulatory arrest was(58.7±17.6)minutes.After operation,17 patients suffered from kidney injuries,among which 3 patients developed acute renal failure and recovered gradually after treated with dialysis.14 patients suffered from brain injuries,among which 9 patients presented transient mood disorder and 5 patients developed functional nerve injuries,but all of them were reversible.Univariate analysis showed that the duration of cerebral oxygen saturation(rSO_(2))below 40%and the maximum decrease rate of rSO_(2)were significantly associated with brain injuries.Multivariate analysis showed that only the duration of rSO_(2) below 40%was associated with brain injuries.In addition,multivariate analysis showed that the total duration of circulatory arrest was significantly associated with kidney injuries and perioperative infections.Conclusion The deep hypothermic circulatory arrest is the key to the successful implementation of pulmonary thromboendarterectomy,and it is safe under scrupulous organ protection measures.

关 键 词：肺动脉血栓内膜剥脱术 深低温停循环技术 脏器保护 脑损伤 肾损伤 

分 类 号：R654.3[医药卫生—外科学]