浅低温体外循环心脏不停跳心内直视手术2962例临床探究

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1、浅低温体外循环心脏不停跳心内直视手术2962例临床探究【摘要】目的总结浅低温体外循环不停跳心内直视手术的方法和经验。方法并行循环，不阻断升主动脉，不灌注心脏停搏液；需逆行灌注者，阻断升主动脉后经冠状静脉窦逆行持续灌注机器氧合血，鼻咽温维持在30℃～32℃，在心脏空跳条件下完成心内直视手术。应用该技术实施心脏手术2962例，其中先天性心脏病1873例，心脏瓣膜病和升主动脉瘤患者1089例。结果全组术后住院死亡率为1.45%（53/2962），其中先天性心脏病死亡率为1.33%（25/1873），心脏瓣膜病死亡率为2.57%(28/1089)；全组无气栓和永久性房室传导阻滞病例，术后低心排量综

2、合征发生率0.37%（11/2962）。结论浅低温体外循环不停跳心内直视手术良好的心肌保护效果，降低了低心排量综合征和严重心律失常的发生率，从而明显降低术后死亡率，是临床上可以选择的好方法之一。【关键词】心内直视手术；不停跳；体外循环；浅低温Theexperienceof2962caseswithintracardiacoperationonbeatingheartundermildhypothermiabycardiopulmonarybypassLINShan-chang,HE12Wei,chenMing-wu，etal.DepartmentofCardiothoracicSurger

3、y,theFirstAffiliatedHospitalofGuangxiMedicalUniversity,Nanning530021,China【Abstract】ObjectiveTosummarizethemethodandexperienceofintracardiacoperationonbeatingheartundermildhypothermiabycardiopulmonarybypass.MethodsParallelingcirculationisneededwithoutaorticrootcross-clampingandcardioplegiasolution

4、perfusing;Whentheretrogradeperfusionisrequired,bloodfromtheoxygenatorwasdeliveredcontinuouslyintothecoronaryvesselsviacoronarysinus,immediatelyaftertheaortawascross-clamped.Intracardiacprocedureswentonwiththeemptyheartbeatingrhythmicallywhenthetemperatureatnasopharynxwaskeptfrom30℃-32℃.Among2962ca

5、sesreceivingoperationwiththesemethods,1873ofthemwerewithcongenitalheartdiseases(CHD)andtheother1089withvalvularheartdiseases(VHD)orascendingaorticaneurysms.ResultsThepostoperativehospitalmortalitywas1.45%(53/2962)asawhole,whileitwas1.33%(25/1873)inpatientswithCHD,and2.57%(28/1089)inthosewithVHDor1

6、2ascendingaorticaneurysms.Inthegroup,therewasnotapatientcomplicatedwithsystemicairembolismorpermanentA-V(atrioventricular)block,andtherewas11caseswithLOS(lowoutputsyndrome)afteroperationwhoseincidiencewasonly0.37%.省略ConclusionIntracardiacoperationonbeatingheartshouldbeoneofgoodmethodsclinicallybec

7、auseofitspositiveeffectonmyocardialpreservation,whichcutdowntheincidenceofLOSandseriouscardiacarrhythmiasafteroperation,accordingly,degradedthepostoperativemortalityobviously.【Keywords】Openheartsurgery;Beatinghea