全机器人心脏手术体外循环建立及管理.docVIP

全机器人心脏手术体外循环建立及管理 　 作者：王加利，李佳春，高长青 【摘要】 目的 总结全机器人心脏手术的体外循环（extracorporeal circulation,ECC）建立方法与术中管理经验。方法 使用达芬奇S（da Vinci.S）机器人完成心脏手术25例，其中在ECC下行房间隔缺损修补术12例，二尖瓣成形术1例。12例房间隔缺损患者经股动脉（Fr20）、股静脉（Fr23，Bio-Medicus）及颈内静脉插管（Fr15，Bio-Medicus整体动脉插管）建立体外循环；1例二尖瓣成形术经股动、静脉（Fr24/29，Carpentier双腔静脉插管）插管建立ECC；灌注中全部应用负压辅助静脉引流装置（VAVD），控制负压在-30～-55 mmHg。采用浅低温灌注，连续血气监测（CDI-500）和含血心肌保护方法。结果 13例患者ECC时间98～205（135.9±31.6）min，升主动脉阻断时间50～125（64.8±19.8）min，心脏自动复苏11例，体外除颤复苏2例。术后呼吸机辅助时间7～17（11.1±4.3）h，24 h胸腔引流量120～680（247.5±197.5）ml。均无并发症康复出院。结论 ECC时间和阻断时间较长与手术方法等因素有关，灌注中使用VAVD、连续血气监测和加强ECC管理是十分必要的。 【关键词】 体外循环 机器人 辅助静脉引流装置 连续血气监测 Abstract: OBJECTIVE To summarize the way and management of extracorporeal circulation(ECC) with totally robotically assisted cardiac surgery. METHODS Total 25 patients underwent cardiac surgery with da Vinci S robotic surgical system, including 12 patients underwent atrial septal defect repair (ASDR) and 1 patient underwent mitral valvuloplasty (MVP). The ECC was achieved with femoral arterial cannula (Fr20), femoral venous cannula (Fr23, Bio-Medicus) and right internal jugular venous cannula (Fr15, Bio-Medicus) in patients for ASDR, and with femoral arterial and venous cannulae (Fr24/29) in patients for MVP. For all cases, vacuum-assist venous drainage (VAVD) and continuous blood gas monitoring devices were used during ECC. RESULTS The ECC time was 98-205 (135.9±31.6)min and aortic cross-clamp time was 50-125(64.8±19.8)min. Automatic cardiac resuscitation occurred in 11 patients, while other 2 cases needed external defibrillation. The postoperative intubation time were 7-17(11.1±4.3)h, the volume of drainage in 24hs post-operations were 120-680 (247.5±197.5)ml. CONCLUSION The long ECC time and aortic cross-clamp time are related to the operation skill . Using VAVD and continuous blood gas monitoring devices and strengthening management during ECC are extremely necessary. Key words： Extracorporeal circulation;Robotics;Vacuum-assist venous drainage;Continuous blood ga