体外循环技术用于非心脏外科手术探析.doc

体外循环技术用于非心脏外科手术探析 　【关键词】 体外膜肺氧合 摘要：目的 总结体外循环（CPB）在非心脏外科手术中应用的技术特点及体会，探讨安全有效的方法。〖HT5”H〗方法 回顾39例患者，其中布加氏综合征行根治术29例；颅内巨大基底动脉瘤行夹闭术4例；右肾癌伴下腔静脉瘤栓行右肾及瘤栓清除术2例；气管癌气管梗阻行激光造孔气管内记忆合金成形术2例；气管淀粉样变气管镜下行梗阻疏通术1例；肝脏巨大平滑肌脂肪瘤切除余肝原位移植术1例。CPB技术分别采用深低温停循环（DHCA）26例,其中包括股动-静脉转流（FA-V）未开胸4例；深低温低流量灌注（DHLF）9例；常温静脉-静脉（NHV-V）转流1例；NHV-V体外膜肺氧和（ECMO）呼吸支持2例；常温股动-静脉（NHFA-V）无泵ECMO 1例。结果　CPB转流时间27~231（146.00±41.62）min；心脏阻断时间28~113（56.95±23.02）min；DHCA时间14~63（29.42±11.36）min。低温组最低鼻咽温12.4~20.7(16.78±1.96)℃，最低肛温17.8~25.0(21.57±1.96)℃。35例低温停跳者自动复苏19例（54.28 %）。手术均获得成功，术后早期死亡2例，1例肾癌术后急性肾功能衰竭，另1例布加氏综合征术后2周因应激性溃疡消化道大出血。〖HT5”H〗结论　尽管CPB存在着一定的创伤性、技术性和费用问题，但对某些常规方法不能进行的手术，应用该技术可助手术获得成功。 　　关键词：体外循环；深低温停循环；体外膜肺氧合；布加氏综合征；肾癌；基底动脉瘤；气管 　　Experience with Cardiopulmonary Bypass in Non-Cardiac Surgery 　　Abstract: OBJECTIVE Retrospective study of cardiopulmonary bypass (CPB) technique applied in non-cardiac surgery. 39 patients including 29 cases of Budd-Chiari Syndrome, 4 cases of intracranial basialis aneurysm, 2 cases of tracheal carcinoma and 1 case of tracheal amyloidosis, 2 cases of large inferior vena cava thrombi from renal carcinoma, and 1 case of leiomys lipoma were operated using CPB technology. Different ways of CPB were adopted as follow: 26 patients received deep hypothermia and circulatory arrest (DHCA) including 4 cases with femoral A-V perfusion without open chest, 9 patients were supported using hypothermia and low flow (DHLF) perfusion, 1 patient using veno-venous bypass in normothermia，2 patients using veno-venous extracorporeal membrane oxygenation （ECMO） and 1 patient femoral A-V bypass without pump ECMO respectively. RESULTS The CPB time was 27~231（146.00±41.62）min.The aortic clamping time was 28~113（56.95±23.02）min. DHCA time 14~63（29.42±11.36）min. The lowest nasopharyngeal temperature was 12.4~20.7(16.78±1.96)℃. The lowest rectal temprature was 17.8~25.0(21.57±1.96)℃. 19 of（54.28 %）35 cases resuscitated automatically. 2 cases died of renal failure and alimentary canal massive haemorrahage early post