全胸腔镜心脏不停跳三尖瓣手术的体外循环管理  

Management of extracorporeal circulation with beating heart in the totally thoracoscopic cardiac surgery for the isolated tricuspid valve disease

作　　者：李天宝 张永苹 张杰成 曾嵘[2] 黄焕雷[1] 章晓华[1] 凌云[1] 周成斌[1] Li Tianbao;Zhang Yongping;Zhang Jiecheng;Zeng Rong;Huang Huanlei;Zhang Xiaohua;Ling Yun;Zhou Chengbin(Department of Cardiovascular Surgery,Guangdong Provincial People's Hospital,Guangdong Cardiovascular Institute,Guangdong Guangzhou 510080,China)

机构地区：[1]广东省人民医院,广东省心血管病研究所,广州510080 [2]广东省人民医院南海医院,佛山528251

出　　处：《中国体外循环杂志》2022年第2期67-70,96,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的 总结全胸腔镜心脏不停跳三尖瓣手术体外循环(ECC)管理经验。方法 回顾性分析2017年2月至2021年3月本院心外科121例行全胸腔镜心脏不停跳三尖瓣手术患者的ECC及其围术期资料,其中三尖瓣成形110例,三尖瓣置换11例。再次心脏手术101例。ECC中60例采用浅低温,61例采用常温,均不阻断升主动脉维持心脏跳动。63例采用股动脉、股静脉和颈内静脉插管,58例采用股动脉和股静脉插管,ECC中使用负压辅助静脉引流(VAVD)技术和超滤技术。结果 全组患者ECC时间(125.08±37.64)min,术后呼吸机辅助时间15.0(8.0,22.5)h, ICU停留时间2.0(1.0,4.0)d。有6例患者围术期死亡,均为再次心脏手术,其余115例痊愈出院,术后住院天数7.0(5.0,12.0)d。使用单静脉插管组患者的ECC时间少于双静脉插管组患者(P<0.05);老年组患者的术后住ICU时间、术后住院天数及死亡率均显著高于中青年组患者(P<0.05)。结论 全胸腔镜心脏不停跳三尖瓣手术中个体化的体外循环插管及灌注流量,常规使用VAVD和超滤技术,可以保障手术的顺利进行,但老年患者的手术风险仍较高。Objective To summarize the experience of extracorporeal circulation(ECC) with beating heart in the totally thoracoscopic cardiac surgery for the isolated tricuspid valve disease. Methods The ECC and perioperative data of 121 patients underwent thoracoscopic tricuspid valve surgery with beating heart from February 2017 to March 2021 were retrospectively analyzed, including 110 cases of tricuspid valve repair and 11 cases of tricuspid valve replacement. Sixty cases were treated with mild hypothermia and 61 cases were treated with normal temperature during ECC under beating heart. The artery cannulation was at site of femoral artery in all cases. There were 63 cases with double vein cannulation via femoral vein and internal jugular vein, and 58 cases with single vein cannulation via femoral vein. The vacuum assisted venous drainage(VAVD) and ultrafiltration technology were used in all cases. Results The ECC time of all patients was 125.08±37.64 min, the postoperative ventilator assisted time was 15.0(8.0,22.5) h, and the ICU stay time was 2.0(1.0,3.0) d. Six patients died during perioperative period, and all of them were re-do cardiac procedure. The other 115 patients discharged from hospital at postoperative 7.0(5.0,12.0) d. The ECC time in the single vein cannulation group was less than that in the double vein cannulation group(P<0.05). The ICU stay time, postoperative hospitalization days and mortality of elderly patients were significantly higher than those of young and middle-aged patients(P<0.05). Conclusion Individualized ECC cannulation, perfusion flow, VAVD and ultrafiltration technology can be benefit for the totally thoracoscopic tricuspid valve surgery with beating heart, but the surgical risk of elderly patients is still high.

关 键 词：全胸腔镜 体外循环 心脏不停跳 三尖瓣 

分 类 号：R654.2[医药卫生—外科学]