左心转流用于胸腹主动脉置换术的体外循环管理探讨  

The management of left heart bypass for thoracoabdominal aortic aneurysm

作　　者：刘超启 陈洪松 赖颢 时慧 罗海燕 王春生 李欣 Liu Chaoqi;Chen Hongsong;Lai Hao;Shi Hui;Luo Haiyan;Wang Chunsheng;Li Xin(Department of Cardiovascular Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]上海复旦大学附属中山医院心外科,上海200032

出　　处：《中国体外循环杂志》2022年第2期71-74,共4页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金面上项目(82070484)。

摘　　要：目的 探讨胸腹主动脉瘤患者的左心转流体外循环管理方法。方法 回顾性分析2012年8月至2018年3月期间本院应用左心转流技术行胸腹主动脉置换术患者15例,其中男9例,女6例。记录患者术前一般情况,术中及术后临床资料,总结胸腹主动脉瘤患者左心转流体外循环管理经验。结果 左心转流或体外循环平均时间(147±72.1)min。呼吸机辅助通气时间平均(60.0±60.8)h,住院时间平均(30.7±22.9)d。术后急性肾损伤4例(26.6%),其中3例(20%)患者经过血液透析治疗后肾功能恢复,1例(6.7%)患者因多器官功能衰竭死亡。术后脊髓损伤4例(26.6%),其中2例(13.3%)为轻瘫,经锻炼及对症支持治疗后恢复,另2例(13.3%)患者为截瘫。肺部并发症3例(20%,治疗后痊愈)。死亡患者2例(13.3%),其中术中1例(6.7%),术后1例(6.7%)。结论 左心转流下行胸腹主动脉置换术是可行且安全有效的,严密监测转流期间各项指标并进行积极的脏器保护是手术成功的重要保障。Objective To investigate the management of left heart bypass for thoracoabdominal aortic aneurysm. Methods Retrospective analysis was performed on 15 patients who underwent thoracic and abdominal aorta replacement surgery by left heart bypass technique in our hospital from August 2012 to March 2018, including 9 males and 6 females. We collected and analyzed preoperative, operative and postoperative clinical data of these patients. Results The mean time of left heart bypass or extracorporeal circulation(ECC) was(147±72.1) min. The average duration of assisted ventilation was(60±60.8) h, and average length of hospital stay was(30.7±22.9) d. There were 4 cases(26.6%) of postoperative acute kidney injury(3 cases recovered from renal injury after dialysis, 1 case died), 4 cases(26.6%) of postoperative spinal cord injury(2 cases were paresis and recovered after treatment, 2 cases were paraplegia), 3 cases(20%) of pulmonary complications(all recovered after treatment). 2 cases died(13.3%). one case died during operation and the other died after operation. Conclusion Thoracic and abdominal aorta replacement under left heart bypass is feasible, safe and effective. Closely monitoring patient’s indicators and active organ protection during left heart bypass are important guarantees for the success of surgery.

关 键 词：左心转流 胸腹主动脉瘤 体外循环 

分 类 号：R654.3[医药卫生—外科学]