摘要
目的:探讨心脏不停跳心内直视手术体外循环方法和经验。方法:1998.7～2002.10中共159例病人用该灌注方法,即在常温或浅低温下、上下腔静脉阻断、心脏在有持续血供、主动脉阻断或不阻断心脏跳动的情况下进行的心内直视手术,主动脉阻断时冠状静脉窦持续逆灌。结果:所有病人全部安全脱机,一例因术后出血、一例因低心排而死亡,死亡率1.26%,余均康复出院,未发现气栓并发症。鼻温≤30℃与鼻温>30℃两组病人室颤发病率有显著差异(P<0.01)。转机时间≤60分钟与转机时间>60分钟患者血尿的发病率有显著差异(P<0.01)。结论:心脏不停跳心肌保护方法由于心肌有持续的氧合血供应,不存在心肌缺氧过程及再灌注损伤,且体外循环辅助时间短,缩短体外循环时间,有利于各器官的保护。但浅低温、主动脉不阻断、视野回血较多吸引破坏增加,又使该方法表现出潜在的危险性,故临床应用有一定的范围,特别在术中回心血多的病人要注意,且应用范围与手术医生有关。
Objective To discuss the technique and evaluate the experience of cardiopulmonary bypass(CPB) under beating-heart surgery.Methods 159 cases of different series of cardiac diseases between July 1998 and October 2002 were performed under bearting-heart surgery without aortic clamp during CPB. Results All patients were weaned off CPB safely and discharged from hospital healthly except one patient died from bleeding and another from low cardiac output.There was no air embolism.The rate of hemoglobinuria was significantly difference (p<0.01) between CPB times less than 60 minutes and CPB times more than 60 minutes.The rate of ventricular fibrillation was significantly high in natal tempeture not more than 30℃groups.Conclusions Continuously warm blood perfusion may be a ideal myocardial protection. During beating-heart surgery.Beating-heart surgery with CPB may reduce ischemic-reperfusion injury and need less CPB times as that of normal CPB.
出处
《安徽卫生职业技术学院学报》
2003年第2期22-24,共3页
Journal of Anhui Health Vocational & Technical College
