1382例体外循环中温度管理的临床研究.docVIP

1382例体外循环中温度管理的临床研究 【关键词】 体外循环 低温 复温 Abstract: OBJECTIVE To retrospect the clinical technique of temperature management during extracorporeal circulation (ECC). METHODS 1382 cases underwent open heart surgery with ECC were devided into three groups according to the lowest nasopharyneal temperature: mild hypothermia group (32℃-35℃), moderate hypothermia group (26℃-31℃) and deep hypothermia group (＜25). After the rectal temperature of all patients was rewarming to 36℃, the difference of rewarming time and rewarming velocity among three groups was compared. RESULTS The lowest rectal temperature was (34.3±0.7)℃ in mild hypothermia group,(30.2±2.5)℃ in moderate hypothermia group and (18.7±4.1)℃ in deep hypothermia group. Average rewarming time was (11.3±3.5) min, (28.5±7.6) min and (74.3±20.6) min, respectively. Average rewarming velocity was (0.42±0.17)℃/min, (0.31±0.09)℃/min and (0.21±0.11)℃/min,respectively. These difference among three groups had statistical significance(P＜0.05). All patients recovered well after operation. No surgical death or neurologic complications occurred. CONCLUSION Rewarming time and velocity during ECC should be carefully considered according to the extent of hypothermia in order to avoid postoperative complications. Key words： Extracorporeal circulation; Hypothermia; Rewarming 体外循环（extracorporeal circulation，ECC）技术在外科领域的应用越来越广泛，不同手术要求温度不同，流量也不同，为减少各器官功能损伤及术后并发症，应严格控制好温度。特别是应用深低温、中低温技术时复温过程尤为重要。本文对1382例ECC下外科手术患者复温情况进行临床经验分析。 1 资料与方法 1.1 临床资料 1997年8月至2007年12月间共有1382例ECC下行外科手术的患者，年龄5～65岁，体重14～105 kg。其中浅低温患者438例，包括房间隔缺损、冠心病；中低温患者785例，包括各类风湿性心脏病、先天性心脏病、冠心病等；深低温患者159例，包括大血管手术、复杂先天性心脏病手术、布加氏综合征（Budd-chiaris Syndrome） 根治术、颅内巨大基底动脉瘤夹闭术等。按最低鼻咽温分为浅低温（32～35），中低温（26～31），深低温（＜25）三组［1］。 1.2 ECC方法 ECC全部采用进口人工心肺机STOCKER-型和JOSTRA-20型；进口变温水箱为STOCKER-型和JOSTRA-3型，进口膜式氧合器SAFEMAX、SAFEMINI、TERUMO-CAPIOX·SX；JOSTRA QUADROX HMO2000型。预充液主要成分为乳酸钠林格氏液、羟乙基淀粉代血浆、20%人血白蛋白、NaHCO3和20%甘露醇。术中用药主要有：青霉素或头孢菌素、肝素钠、地塞米松、MgSO4、CaCl2、KCl等。 ECC复温期间成人动脉灌注流量调控在50～70 ml/（k