高危冠脉搭桥手术体外循环管理与分析.docVIP

高危冠脉搭桥手术体外循环管理与分析 　　 　　 【摘要】 目的 本文回顾总结我院自2010年1月至2011年6月施行的152例高危冠脉搭桥手术体外循环的管理体会。方法 此152例手术患者均为年龄大于65周岁、冠脉病变3支以上的重症患者，其中左主干病变者为135例，合并其他瓣膜疾病者42例，均在体外循环(ECC)下行冠脉搭桥手术(CABG)。采用浅中度低温(30℃~32℃)，中高流量［2?4~3?0 L/(min/m2)］灌注。心肌保护采用7℃~10℃ 4∶ 1稀释血停搏液顺灌与逆灌相结合。结果 本组CPB总时间85~199 min,主动脉阻断时间38~147 min，152例均顺利脱离体外循环。148例痊愈出院，术后早期死亡4例，2例死于颅内出血，另2例死于多脏器功能不全。结论 优质的设备，控制适当的晶/胶比值，加强血气和凝血功能的检测，注意围术期脑功能和肾功能的保护，必要时使用人工超滤，以及注重围术期激素和抗生素的应用对患者的治疗和恢复至关重要。 　　 【关键词】 冠脉搭桥手术;体外循环The management and analysis of extracorporeal circulation in High risk of coronary artery bypass grafting YANG Lei?yi,QIAN Xiao?liang,YAO Dong?feng.The People’s Hospital of Henan Province,Henan 450003,China 　　 【Abstract】 Objective Review this article in hospital during January 2010 to June 2011 in 152 cases of coronary artery bypass grafting(CABG) of high risk to consult the management and analysis of extracorporeal circulation(ECC)? Methods 152 cases of patients were aged more than 65 years old, pathologied greater than 3 in arteria coronary, in so far as the left main coronary artery disease in 135 cases, merged a different valve disease is 42 cases, were made the coronary artery bypass grafting (CABG) at the extracorporeal circulation(ECC)?Used on low temperature (30℃~32℃), high flow ［2?4~3?0L/(min/m2)］ pouring into? The protection of cardiac muscles adopt 7℃ 4: 1 blood cardioplegia with dilution that combined with shuenn guanhe and inverse guanhe? Results Total time of CPB was 85~199 min, aortic cross?time was 38~147 min, 152 cases had been functioning normally out of extracorporeal circulation? 148 cases recovered and discharged from hospital, conclusionsearly died in 4 cases, 2 cases died of internal hemorrhage of skull, additionally, two cases died of multiple organ dysfunction? Conclusion High quality equipment, control the appropriate crystal/phyxia ratio, strengthen the blood and coagulationin detection, perioperation brain function and renal function, if necessary, using artificial ultrafiltrative and strsse