浅低温体外循环心脏不停跳心内直视手术２９６２例临床研究.DOCVIP

临床医学论文-浅低温体外循环心脏不停跳心内直视手术２９６２例临床研究 ??????????????? 作者：林善昌　何巍　陈铭伍　周华富　郑宝石　郭建极　刘翔 【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2 962例，其中先天性心脏病1 873例，心脏瓣膜病和升主动脉瘤患者1 089例。结果 全组术后住院死亡率为1.45%（53/2 962），其中先天性心脏病死亡率为1.33%（25/1 873），心脏瓣膜病死亡率为2.57%(28/1 089)；全组无气栓和永久性房室传导阻滞病例，术后低心排量综合征发生率0.37%（11/2 962）。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 　　【Abstract】ObjectiveTo summarize the method and experience of intracardiac operation on beating heart under mild hypothermia by cardiopulmonary bypass. MethodsParalleling circulation is needed without aortic root cross-clamping and cardioplegia solution perfusing;When the retrograde perfusion is required,blood from the oxygenator was delivered continuously into the coronary vessels via coronary sinus,immediately after the aorta was cross-clamped. Intracardiac procedures went on with the empty heart beating rhythmically when the temperature at nasopharynx was kept from 30℃-32℃.Among 2962 cases receiving operation with these methods ,1 873 of them were with congenital heart diseases (CHD) and the other 1 089 with valvular heart diseases (VHD) or ascending aortic aneurysms. ResultsThe postoperative hospital mortality was 1.45%(53/2962) as a whole,while it was 1.33%(25/1873) in patients with CHD, and 2.57% (28/1089) in those with VHD or ascending aortic aneurysms. In the group,there was not a patient complicated with systemic air embolism or permanent A-V(atrioventricular) block,and there was 11 cases with LOS(low output syndrome) after operation whose incidience was only 0.37%. 　　ConclusionIntracardiac operation on beating heart should be one of good methods clinically because of its positive effect on myocardial preservation,which cut down the incidence of LOS and serious cardiac arrhythmias after operation,accordingly,degraded the postoperative mortality obviously. 　　【Key words】 Ope