主动脉灌注分流逆灌心脏跳动中主动脉瓣置换术的研究  

THE STUDY OF THE RETROGRADE PERFUSION DURING THE REPLACEMENT OF AORTIC VALVE ON BEATING HEART

作　　者：何巍[1] 林辉[1] 覃家锦[1] 罗玉忠[1] 温仁祝[1] 郑宝石[1] 廖寿合[1] 冼磊[1] 冯旭[1] 蒋志华[1] 

机构地区：[1]广西医科大学第一附属医院心胸外科,南宁530021

出　　处：《广西医科大学学报》2002年第6期783-784,共2页Journal of Guangxi Medical University

摘　　要：目的 :探讨简化主动脉灌注分流逆灌心脏跳动中主动脉瓣置换术的操作 ,以获得良好的心脏保护效果。方法 :主动脉灌注管接“Y”接头 ,分一条管 (2 0 cm)灌注升主动脉 ;另接一条管 (30 cm )与逆行灌注管相接 ,经冠状静脉窦逆行灌注。升主动脉阻断时便开始逆行灌注 ,不灌注心脏停跳液 ,平均动脉压 (MAP)维持在 5 .5～ 6 .5 k Pa之间 ,鼻咽温度控制在 (32± 1)℃左右 ,放置左房管作左心吸引。结果 :术后应用硝普钠、硝酸甘油控制 MAP维持在 9.5～ 10 .5 k Pa之间 ,多巴胺用量 5 μg/ kg· min- 1以下。本组 86例术后无低心排量综合征和严重心律失常 ,心肌保护效果良好。术后 7d急性肾衰死亡 1例 ,大量渗血输血后肾衰死亡 1例 ,肺部感染死亡 1例 ,住院手术病死率 3.4 8%。结论 :主动脉灌注分流逆灌心脏跳动中主动脉瓣膜置换术 ,能维持逆灌所需的灌注压 ,有良好的心肌保护效果 ,简化了操作程序 ,临床上应用方便。Objective:To evaluate the retrograde perfusion that shunt from the filling canal of aorta during the replacement of aortic valve on beating heart, simplify the operation and obtain better efficacy of myocardium protection. Methods: The filling canal of aorta connect a 'Y' joint.The 'Y' joint connects two canals.One(20 cm) connects the ascending aorta,and the other(30 cm) connects the retrograde perfusion canal undergoes retrograde perfusion via coronary sinus. After aortic cross clamping the heart was perfused. No cardioplegia solution was used,MAP remains at 5.5～6.5 kPa,and the temperature of nasopharynx remains at (32±1) ℃.The left atrium drain was put into the left atrium in order to drain the blood.Results:After operation MAP remains at 9.5～10.5 kPa.The dose of dopamine was no more than 5 μg/kg·min -1 .There was no low cardiac output syndrome and serious arrhythmia in 86 cases.The efficacy of myocardium protection was better.One case who was operated on 7 days ago died of acute renal failure;one case after blood transfusion died of acute renal failure;and one case died of pulmonary infection.There were 3 hospital deaths with a postoperative mortality of 3.48%.Conclusions: The retrograde perfusion that shunts from the filling canal of aorta during the replacement of aortic valve on beating heart can simplify the operation,and maintain the pressure that the retrograde perfusion need.The treatment obtains better efficacy of myocardium protection.

关 键 词：主动脉灌注 心脏跳动中 瓣膜置换术 逆行灌注 

分 类 号：R654.2[医药卫生—外科学]