简易左心转流在心脏不停跳冠状动脉旁路移植术中的应用  

Clinical application of left ventricular bypass technique in off-pump coronary artery bypass grafting

作　　者：钱晓亮 陈月 赵子牛 李建强 孙永辉 李建朝 杨雷一 程兆云 Qian Xiaoliang;Chen Yue;Zhao Ziniu;Li Jianqiang;Sun Yonghui;Li Jianchao;Yang Leiyi;Cheng Zhaoyun(Department of Extracorporeal Circulation,People's Hospital of Henan Province,People's Hospital of Zhengzhou University,Fuwai Central China Cardiovascular Disease Hospital,Henan Zhengzhou 450003,China)

机构地区：[1]河南省人民医院郑州大学人民医院阜外华中心血管病医院体外循环科,郑州450003 [2]河南省人民医院郑州大学人民医院阜外华中心血管病医院麻醉与围术期医学科,郑州450003 [3]河南省人民医院郑州大学人民医院阜外华中心血管病医院心血管外科,郑州450003

出　　处：《中国体外循环杂志》2023年第4期216-218,256,共4页Chinese Journal of Extracorporeal Circulation

基　　金：河南省医学科技攻关计划(联合共建)项目(20190796)。

摘　　要：目的总结6例危重冠心病患者在左心转流辅助下行不停跳冠状动脉旁路移植术的应用经验和疗效观察。方法回顾性分析本院在2021年2月至12月收治的6例危重冠心病患者,在全麻下经右上肺静脉-离心泵-保温装置-升主动脉插管建立左心转流行不停跳冠状动脉旁路移植手术的临床资料,通过观察辅助治疗前后的血流动力学及血气指标的变化,评价辅助效果。结果左心转流辅助流量平均(3.2±0.5)L/min,辅助时间平均(83±12)min,辅助后患者的血流动力学指标较辅助前显著改善,肺动脉压由(45±15)mmHg下降至(27±13)mmHg(P=0.039);平均动脉压由(63±12)mmHg上升至(71±11)mmHg(P=0.045),但脉压较辅助前降低。患者动脉血气指标无明显改变,pH、氧分压、二氧化碳分压、血糖、乳酸在辅助前后差异无统计学意义;红细胞压积值由辅助前的(0.35±0.01)下降至(0.31±0.02),有统计学差异(P=0.001)。患者在手术结束后均成功脱离左心辅助,术后ICU气管插管带管时间(8.5±1.9)h,ICU停留时间(1.8±0.9)d,均顺利出院。结论在简易左心转流下行不停跳冠状动脉旁路移植术,通过减少经过左心的血液容量负荷,避免了术中搬动心脏时血流动力学的剧烈波动,安全可行。Objective To summarize the application experience and efficacy of off-pump coronary artery bypass grafting(CABG)by left ventricular bypass technique in 6 patients with critical coronary heart disease.Methods A retrospective analysis was made by the clinical data of 6 patients with critical coronary heart disease admitted in our hospital from February 2021 to December 2021.The left ventricular bypass was performed via right upper pulmonary vein-centrifugal pump-thermal insulated device-ascending aorta intubation under general anesthesia.The effects of left ventricular bypass technique were evaluated by observing the changes of hemodynamics and blood gas indexes.Results The mean flow rate of left ventricular bypass was(3.2±0.5)L/min,and the average assistance time of left ventricular bypass was(83±12)min.The hemodynamic parameters of patients after the assistance were significantly improved compared with those before the assistance.The pulmonary artery pressure significantly decreased from(45±15)mmHg to(27±13)mmHg(P=0.039),and the mean arterial pressure significantly increased from(63±12)mmHg to(71±1)mmHg(P=0.045),but the pulse pressure was lower than that before assistant treatment.The patients'arterial blood gas did not show significant changes,and there were no statistically significant differences in pH,partial oxygen pressure(PO2),partial carbon dioxide pressure(PCO2),blood glucose,and lactate before and after assisted therapy.There was no significant change in arterial blood gases.Hematocrit significantly decreased from(0.35±0.01)to(0.31±0.02)during left ventricular bypass(P=0.001).All patients were successfully withdrawal from left ventricular assist after the operation.The intubation time in ICU was(8.5±1.9)hours,and the ICU stay time was(1.8±0.9)days.All patients were discharged from hospital successfully.Conclusions The off-pump CABG under simple left ventricular bypass could reduce the volume load of the left heart and avoid the violent fluctuation of hemodynamics when moving the heart during t

关 键 词：冠状动脉旁路移植术 左心转流 体外循环 

分 类 号：R654.2[医药卫生—外科学]