大血管手术中的体外循环管理_临床医学论文.docVIP

大血管手术中的体外循环管理_临床医学论文 大血管手术中的体外循环管理_临床医学论文 作者：王加利，李佳春，高长青，丁振元，骆荩，张涛 【摘要】 目的 总结各种大血管手术中的体外循环(extracorporeal circulation,ECC)方法及管理经验。方法 ECC下完成各种大血管手术61例，升主动脉人造血管置换、Bentall手术采用升主动脉-右房插管，中低温体外循环方法；升主及半弓置换手术采用腋动脉-右房插管，深低温停循环方法；全主动脉弓置换（象鼻术）+带膜支架植入手术采用腋动脉-右房插管，深低温停循环＋顺行性脑灌注方法。心肌保护均采用4∶1含血冷停搏液顺行＋逆行方法灌注。结果 升主及半弓置换10例，Bentall手术33例，Cabrol＋半弓置换手术1例，Bentall＋升主及半弓置换手术9例，Bentall＋全弓置换（象鼻术）+带膜支架植入手术2例，升主及全弓置换+带膜支架植入术5例，David手术1例，同期行冠状动脉旁路移植术5例。采用腋动脉插管27例。ECC时间129～414（182.3±51.9）min, 升主动脉阻断时间68～259（137.0± 35.0）min，最低鼻咽温13.8～28.0（22.8±3.5）℃，深低温停循环26例，停循环时间15～55（29.2±11.4）min，停循环时最低鼻咽温13.8～21.0(17.7±1.9) ℃,转流中尿量150～4900（1326.1±1061.2）ml，超滤量900～5000（2783.9±1246.6）ml，术后呼吸机辅助时间11～192（27.8±32.3）h，术后24h胸腔引流量120～1850（523.2±353.1）ml。术后死亡4例，余者痊愈出院。结论 针对不同的大血管手术选择不同的ECC方法并加强围术期ECC管理可以显著减少并发症，提高手术的成功率。 【关键词】 体外循环；大血管手术；深低温停循环；选择性脑灌注 Abstract: OBJECTIVE To summarize the experience of extracorporeal circulation (ECC) during operations on great artery. METHODS Total sixty one cases of great artery surgery were completed with ECC. The moderate hypothermia was used for ascending aorta replacement or Bentall operations, deep hypothermic circulatory arrest(DHCA) was used for ascending aorta with hemi-arch replacement operations, DHCA and selected cerebral perfusion were used for total aortic arch replacement combined with elephant trunk implantation. Cardioplegia with blood was used for myocardium protection. Right auxiliary artery cannulation was routinely used for aortic arch operations. RESULTS The ECC time was 129-414（182.3±51.9）min, aortic clamp time was 68-259（137.0± 35.0）min, the lowest temperature was 13.8-28.0（22.8±3.5）℃, DHCA was used in 26 cases, arrest circulation time was 15-55（29.2±11.4）min. Ultrafiltration volume was 900-5000（2783.9±1246.6）ml, intubation time was 11-192（27.8±32.3）h, drainage volume for 24 h was 120-1850（523.2±353.1）ml, 4 patients died after operation. CONCLUSION In order to decrease the complications and ensure successful operation, appropriate extracorporeal circulatio