心内直视手术后出血二次开胸止血  

Reoperation for excessive postoperative bleeding following open heart surgery

作　　者：乔晨晖[1] 邱全胜[1] 阎宝君[1] 蔡萍[1] 郅兴义[1] 赵松[1] 赵高峰[1] 卫洪超[1] 张新[1] 张卫[1] 史昌平[1] 李军[1] 

机构地区：[1]郑州大学第一附属医院胸心外科,450052

出　　处：《河南外科学杂志》2002年第4期4-5,共2页Henan Journal of Surgery

摘　　要：目的:总结17例心内直视手术后出血二次开胸止血病人的出血原因及处理得失。方法:17例病人因心内直视手术后大出血行二次开胸止血术,其中男12例,女1例,年龄7～66岁,平均(27.7±16.3)岁,体重16～64kg,平均(43.37±18.5)kg。心内直视手术毕常规置纵隔、心包引流管,胸膜腔敞开者置胸腔引流管。术后保持引流管通畅并监测引流量、心率、血压、中心静脉压。记录心内直视术后至二次开胸止血观察时间,输血量及二次术中探查所见。结果:心内直视术后引流量400～2520ml,平均(1449±622)ml。心内直视术后至二次开胸止血观察时间1～27h,平均(7.1±6.7)h,心脏术后4h以内两次开胸止血7例(41.2％),8h以内二次开胸止血12例(70.1％)。二次开胸术中发现活动性出血1.1例(64.7％),渗血5例(38.5％)。输库血400～3200ml,平均(1820±919)ml。17例病人中切口感染5例(29.4％),死亡3例(17.6％)。结论:心内直视手术后出血是一凶险并发症。一旦出现,尤其术后8h以内,有二次开胸止血指征,应尽速开胸止血。心内直视手术后出血大部分是由于止血或结扎不严密造成的,重在预防。Aim: To review the bleeding cause and reoperation experience in 17 patients with excessive postoperative bleeding after open - heart surgery. Methods: 17 patients underwent reexploration for excessive postoperative bleeding after open -hear surgery. There were 12 men and 5 women with an age range from 7 to 66 years ( mean :27.7 ±16.3 years) . And the body weight of the patients was from 16 to 64 kg ( mean : 43. 3 ±18. 5 kg ) . The volume of postoperative mediastinal chest tube drainag, the heart rate, blood pressure, central vein pressure and allogenic blood transfusion were observed. The duration fron rhe, postoperation of open heart to reoperation for excessive bleeding, and the cause of bleeding found in reoperation were recorded. results: The volume of postoperative drainage following open - heart surgery was 400 to 2520(mean : 1449 ± 622) ml. The time of observation before reoperation was 1 to 27 hours. 7 cases were reoperated upon within the first 4 hrs after oprn - heart surgery, and 12cases within the first 8 hours. There were 11cases (64.7% ) with active hemorrhage and 6 cases (35. 3% ) with general ooze. The infection rate and mortality in patients undergoing reoperation were 29.4% and 17. 6% respectively . Conclusion: Excessive postoperative bleeding following open heart surgery in itself is a serious complication . Reoperation should be carried out as early as possible in the presence of the appropriate indication , especially during the first 8 postoperative hours. The cause of excessive postoperative bleeding following open - heart surgery results mostly from the unstrictness of hemostasis or lingation . Stress should be laid upon prevention.

关 键 词：心内直视手术 术后并发症 出血 二次开胸 止血 原因 

分 类 号：R654.2[医药卫生—外科学] R619.[医药卫生—临床医学]