體外循環(huán)心臟跳動(dòng)中心內(nèi)直視手術(shù)2100例臨床分析-展示頁(yè)
2025-01-26 22:28本頁(yè)面
【正文】 METHODS2100 cases received intracardiac operations onpump beatingheart technique. 1442 patients of them were with congenital heart diseases (CHD),and 658 with valvular heart diseases (VHD). The operative technique was improved with establishing simultaneous left atrium and ventricle suction and integrated sequential deairing procedure. RESULTSThe operative mortality was % (35/2100), while the mortality was % (27/1442) in patients with CHD,and % (8/658) in those with VHD. There was no patient plicated with systemic air embolism or permanent atrioventricular conduction block. CONCLUSIONOur results suggested that onpump beatingheart was a reliable technique for intracardiac procedures in patients with CHD or VHD. The technique might extenuate heart and lung injury by hypothermia and ischemiareperfusion during cardiopulmonary bypass. Cardiac conduction tissue was prevented from operative injury while heart beating. Key words：Beatingheart。Hypothermia 近年來(lái)，淺低溫體外循環(huán)心臟跳動(dòng)中心內(nèi)直視手術(shù)技術(shù)日益受到重視，但也存在較多爭(zhēng)議。本文著重報(bào)告手術(shù)技術(shù)和早期療效。先天性心臟畸形矯治術(shù)1442例（見(jiàn)表1）。同時(shí)行巨大左心房折疊術(shù)83例，左心房血栓清除術(shù)53例，合并動(dòng)脈導(dǎo)管未閉經(jīng)肺動(dòng)脈縫合11例。常規(guī)建立體外循環(huán)（extracorporeal circulation，ECC），ECC中矯正型大動(dòng)脈轉(zhuǎn)位矯治術(shù)2例降溫至30℃～32℃，勒緊腔靜脈阻斷帶，不鉗閉升主動(dòng)脈，不灌注心臟停搏液，保持心臟緩慢跳動(dòng)。 心內(nèi)畸形修復(fù)手術(shù)中，先切開(kāi)右心房，經(jīng)未閉卵圓孔或房間隔小切口，將左心房減壓管經(jīng)二尖瓣口置入左心室，防止二尖瓣閉合并持續(xù)進(jìn)行吸引，以保持手術(shù)視野清晰。 完成心內(nèi)操作后，分步驟依次排除心內(nèi)氣體，縫閉房間隔切口前，搖動(dòng)手術(shù)床成頭低左傾位，主動(dòng)脈根部插入排氣針，停左心引流，使血液逐步充盈左心室將氣體排向左心房，麻醉師配合膨肺，將氣體經(jīng)房間隔切口排出。保持主動(dòng)脈根部排氣針直至體外循環(huán)結(jié)束，以排出左心內(nèi)可能的殘存氣體。先天性心臟病組死亡27例(%
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