改进型二氧化碳充弥法在体外循环的应用.docVIP

改进型二氧化碳充弥法在体外循环的应用 作者:李旭,陈龙,涂远荣 作者单位：福建医科大学附属第一医院胸外科，福建 福州 350005 【摘要】 目的 介绍一种改进的二氧化碳术野充弥法应用在体外循环(extracorporeal circulation,ECC)手术中以减少术后血循环中微气栓的形成，并利用经颅多普勒超声微气栓检测来证实其有效性。　方法 30例ECC手术病例随机分为二氧化碳组与对照组，前者使用改进后的气体弥散器在ECC期间向术野充弥二氧化碳，后者不进行此项干预。所有病例均以经颅多普勒超声微气栓检测系统于两侧头颅体表检测大脑中动脉血流微栓子信号，在ECC期间分五个时段分别记录和计算单位时间内血流中微气栓数目，两组之间结果进行比较。　结果 微气栓进入脑血流的时间主要发生在主动脉阻断钳开放后3 min的时段。在二氧化碳组该时段微气栓数目为14.9个/min，较对照组42.6个/min显著减少(P0.001)。其它时段内微气栓数目稀少，两组之间比较无显著差异。结论 改进型二氧化碳术野充弥法可以显著减少ECC手术中脑血流微气栓数目。 【关键词】 二氧化碳；排气；微气栓；经颅多普勒超声 　　Impact on a New Carbon Dioxide De-airing Technique for Extracorporeal Circulation 　　LI Xu，CHEN Long, TU Yuan-rong 　　(Department of Thoracic Surgery,The First Affiliated Hospital,Fujian Medical University, Fujian Fuzhou,350005; Department of Thoracic Surgery,Fuzhou General Military Hospital,Fujian Fuzhou 350002，China) 　　Abstract: OBJECTIVE To introduce a new carbon dioxide de-airing method in extracorporeal circulation(ECC) surgery for minimizing cerebral gaseous embolizaiton, and make use of Doppler ultrasonography detecting confirms the efficacy of this new methed. METHODS 30 patients undergoing ECC surgery were randomly divided into two groups. 14 patients in CO2 group were insufflated with CO2 at pericardial cavity via a new designed gas-diffuser during ECC, whereas 16 patients in control group were not. In all patients, both left and right middle cerebral artery Doppler signal were acquired by automatic embolus dectections machine. At five different phases during ECC, gaseous emboli in each phase were calculated and compared in both groups. RESULTS The time of gaseous embolization caming into brain blood stream mostly appears during the phase of aortic clamping removal 3 min. The mean emboli at this phase in control group were 42.6 events per minute. It had been significantly reduced to 14.9 events per minute in CO2 group (P＜0.001). The events in other phases were seldom and there was no significant difference between two groups.