密闭式股股转流在胸腹主动脉置换术的应用  

Closed femoro⁃femoral partial bypass management strategies for thoracoabdominal aortic replacement

作　　者：周阳 黄佳鑫 李建朝 ZHOU Yang;HUANG Jiaxin;LI Jianchao(Department of Extracorporeal Circulation,Shanghai Delta Health Hospital,Shanghai 200000,China;不详)

机构地区：[1]上海德达医院体外循环科,上海200000 [2]阜外华中心血管病医院体外循环科,河南郑州450000

出　　处：《实用医学杂志》2024年第19期2760-2765,共6页The Journal of Practical Medicine

基　　金：河南省医学科技攻关联合共建项目(编号:LHGJ20220112)。

摘　　要：目的探讨密闭式股股转流(closed femoro-femoral partial bypass,C-FPB)在胸腹主动脉置换术中的应用方法和效果。方法回顾性分析2021年4月至2023年5月在C-FPB辅助下完成的70例胸腹主动脉置换术的临床资料,部分联合了腹腔脏器灌注。主要评价指标为术后院内死亡、脑卒中、术后脊髓损伤和血液透析发生率。在开放式股股转流回路的基础上,将静脉管路用10×10×10 mm“Y”形接头分出管路直接连于离心泵入血口,滚压泵后管路用10×10×10 mm“Y”形接头连接于离心泵后和膜式氧合器前,可以建立密闭式股股转流,离心泵灌注下半身,控制滚压泵调控血容量。结果全部病例未观察到系统故障。转流平均时间(101.0±22.2)min,肋间动脉重建平均时间(18.6±5.4)min,平均数量为(4.7±1.8)对,ICU停留平均时间(5.1±1.5)d,平均住院时间(34.4±12.5)d。2例(2.9%)患者术后脑卒中,1例(1.4%)院内死亡,2例(2.9%)发生术后截瘫,术后血液透析7例(10.0%),机械通气时间延长3例(4.3%)。结论密闭式股股转流兼顾了整个手术过程,降低了灌注医师的体外循环管理难度,为胸腹主动脉置换术中远端灌注提供了独特的优势。Objective Discuss the application methods and effects of closed femoro-femoral partial bypass(C-FPB)in thoracoabdominal aortic replacement(TAAAR)surgery.Methods A retrospective analysis of the clinical data of 70 cases of TAAAR assisted by C-FPB from April 2021 to May 2023,some of which combined with abdominal organ perfusion.The main evaluation indicators were in-hospital mortality,postoperative stroke,postop-erative spinal cord injury,and the incidence of hemodialysis.Based on an open-type conventional Cardiopulmonary bypass(CPB)circuit,the venous tubing was split with a 10×10×10 mm"Y"connector directly connected to the inlet of the centrifugal pump,and the tubing after the roller pump was connected to the outlet of the centrifugal pump,while the front of the membrane oxygenator with another 10×10×10 mm"Y"connector to establish a closed femoro-femoral bypass.During bypass,the lower body is perfused by the centrifugal pump,while the upper body is perfused by the roller pump.Results No system failures happen in all cases.The average bypass time was(101.0±22.2)minutes,the average time for intercostal artery reconstruction was(18.6±5.4)minutes,with an average of(4.7±1.8)pairs.The average length of stay in the ICU was(5.1±1.5)days,and the average length of hospital stay was(34.4±12.5)days.2 cases(2.9%)experienced postoperative stroke,1 case(1.4%)resulted in in-hospital mortality,2 cases(2.9%)experienced postoperative paraplegia,7 cases(10.0%)underwent postop-erative hemodialysis,and 3 cases(4.3%)experienced prolonged mechanical ventilation.Conclusion The Closed-type femoro-femoral partial bypass takes the whole surgical process into account,reduces the management difficulty for perfusionist,and provides a unique advantage for distal perfusion during thoracoabdominal aortic replacement surgery.

关 键 词：股静脉-股动脉转流 胸腹主动脉置换术 密闭式体外循环 器官保护 

分 类 号：R654.1[医药卫生—外科学]