负压辅助静脉引流技术在微创心脏手术中的应用.DOCVIP

临床医学论文-负压辅助静脉引流技术在微创心脏手术中的应用 ???????????????????? 作者：王加利，李佳春，高长青，张涛，马兰 【摘要】? 目的 总结在微创心脏手术(MICS)中应用负压辅助静脉引流(VAVD)技术进行体外循环(CPB)的方法及经验。方法 2007年1月至2008年10月完成微创心脏手术的CPB 73例，其中使用达芬奇机器人(da vinci S)完成心脏手术71例，经右侧胸小切口心脏手术2例。1例二尖瓣成形手术患者经股动脉、股静脉插管建立CPB，1例小切口房间隔缺损修补患者经股动脉、股静脉及上腔静脉插管建立CPB，其余71例手术均经股动脉、股静脉及颈内静脉插管建立CPB。CPB采用浅低温、中流量灌注，应用VAVD(负压控制在-30～-60 mmHg)，连续血气监测(CDI-500)及超滤。结果 73例患者CPB时间45～206(116.1±35.5)min，升主动脉阻断时间27～132(58.5±23.6)min，CPB转流中尿量200～1 900(825.5±447.5)ml，超滤量800～4 800(2571.1±885.9)ml，9例患者CPB液体量为零平衡，53例患者CPB液体量为负平衡200～2100(835.8±524.0) ml，术后呼吸机辅助时间7～17(11.1±4.3) h，术后24 h引流量120～680(247.6±197.5)ml，全组病例均顺利停机，无并发症出院。结论 VAVD技术能获得充分的静脉引流，在微创心脏手术CPB中必须使用VAVD才能保证良好的静脉引流。在保证充足的灌注流量的前提下，可以尽量多的滤出液体，达到零平衡或负平衡的目的，VAVD是一项安全有效的技术。 【关键词】? 体外循环;负压辅助静脉引流;微创心脏手术 　　Abstract: OBJECTIVE To summarize the management of cardiopulmonary bypass (CPB) with the technique of vacuum-assist venous drainage (VAVD) in the minimally invasive cardiac surgery (MICS). METHODS Total 73 patients underwent MICS, including 71cases undergoing cardiac surgery with da vinci S robotic surgical system, 2 cases undergoing minimally invasive thoracotomy. The CPB for most of patients was achieved with femoral arterial cannula, femoral venous cannula and right internal jugular venous cannula, except for 1 patient undergoing MVP with femoral arterial cannula, femoral venous cannula and 1 patient undergoing ASDR with femoral arterial cannula, femoral venous cannala and superior vena cava cannula. VAVD was used for all cases during CPB, and the vacuum negative pressure of -30～-60 mmHg was administered to the closed cardiotomy reservoir. RESULTS For all patients, CPB time was 45～206 (116.1±35.5) min and aortic cross-clamp time was 27～132 (58.5±23.6) min respectively during CPB, the urine volume was 200～1 900 (825.5±447.3) ml, ultrafiltration volume was 800～4 800 (2571.1±885.9) ml,and the total fluid balence was subzero-balenced(53 cases) or zero-balenced (9 cases) in most patients. The postoperative ventilation surppo