常规体外循环及闭式体外循环相互转换在心脏手术中管理.docVIP

常规体外循环及闭式体外循环相互转换在心脏手术中管理 　 作者：段大为，李彤，赵成秀，张文芳，胡晓旻，吴鹏，张强 【摘要】 目的 介绍用Medtronic ECMO套包改装成常规体外循环(CPB)管路与闭式体外循环(ECC)管路相互转换的管理方法及注意事项。方法 15例重症心脏病患者，年龄65～82(74±9.3)岁;采用Medtronic ECMO套包改装的常规CPB与闭式ECC管路。其中3例患者开胸前和心内操作完成后采用了闭式ECC;12例患者在心内操作完成后采用闭式ECC。结果 15例患者采用闭式ECC时间31～112(84±24.1)min，常规CPB时间51～84(67±10.1)min。手术后呼吸机辅助时间4～14(8±2.9)h;24 h胸腔引流量110～360(252±62.9)ml。15例患者没有出现血栓栓塞和气体栓塞并均顺利康复出院。结论 应用Medtronic ECMO套包改装的常规CPB与闭式ECC相互转换管路临床应用方便、安全、有效，但要注意防止在旁路接头处形成血栓，防止转换过程中管道内进气。 【关键词】 体外循环;闭式体外循环;心脏手术;管理 　　Abstract: OBJECTIVE To introduce the method and of the Medtronic extracorporeal membrane oxygenation package was modified to common cardiopulmonary bypass(CPB) channel and closed circulation channel switched during operation on heart. METHODS 15 patients with severe heart disease, aged from 65 to 82 (average 74±9.3) years old, were included. Medtronic extracorporeal membrane oxygenation package were modified to common CPB channel and closed circulation channel. Three patients were used closed circulation at before and after operation on heart, 12 patients were used closed circulation after operation on heart. RESULTS For all patients, the common CPB time was 51-84(average 67±10.1)mins, closed circulation time was 31-112(average 84±24.1) mins. Mechanical ventilor assist time was 4～14(average 8±2.9)h; 24h chest drainage was 110～360 (average 252±62.9)ml. All patients didn’t appear thromboembolism and gas embolism and rehabilitation discharge successfully.CONCLUSION It is safe, convenient and feasible that Medtronic extracorporeal membrane oxygenator package is modified to common CPB and closed circulation channel for operation on heart, but must be pay attention to prevent thromboses at shunt adaptor and avoid the air getting into tubing during switching process. 　　Key words： Cardiopulmonary bypass; Closed extracorporeal circulation; Operation on heart; Management 　　目前在心脏外科收治的危重患者不断增多,有许多实施心脏手术的患者需要在手术后用体外循环(cardiopulmonary bypass,CPB)进行心肺功能的辅助，但长时间的常规CPB辅助对血液及机体重要脏器损伤严重，导致部分患者死亡。如果采