全机器人心脏手术的体外循环建立与管理.docVIP

全机器人心脏手术的体外循环建立与管理 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：全机器人心脏手术的体外循环建立与管理 1 1 资料与方法 2 2 结 果 4 3 讨 论 4 文2：50例全机器人房间隔缺损修补术的麻醉方法总结 6 1 资料与方法 7 2 结 果 9 3 讨 论 9 参考文摘引言： 13 原创性声明（模板） 14 文章致谢（模板） 15 正文 全机器人心脏手术的体外循环建立与管理 文1：全机器人心脏手术的体外循环建立与管理 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 (±)min and aortic cross-clamp time was 50-125(±)min. Automatic cardiac resuscitation occurred in 11 patients, while other 2 cases needed external defibrillation. The postoperative intubation time were 7-17(±)h, the volume of drainage in 24hs post-operatio were 120-680 (±)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 gas monitoring 微创外科概念的出现和兴起使传统的外科领域发生了一系列革命性的变化。胸腔镜技术应用于心脏手术曾被认为是 现代 微创心脏外科的代表性手术［1］，但真正带来外科手术微创革命化的是全机器 人外科手术系统。我院从2007年1月至2007年7月开展全机器人心脏手术共25例，其中体外循环(extracorporeal circulation,ECC)下完成全机器人心脏手术13例，取得了满意的手术效果，现将ECC的建立方法及管理经验报道如下。 1 资料与方法 临床资料 2007年1月至2007年7月共完成机器人心脏手术25例，其中12例冠心病患者采用机器人游离乳内动脉，侧胸小切口搭桥手术（MIDCAB）或全机器人搭桥术（TECAB）。12例房间隔缺损患者和1例二尖瓣关闭不全患者在ECC下使用机器人进行缺损修补和瓣膜修复成形