摘要
目的探讨周围体外循环（PECC）在机器人辅助心脏手术中的建立方法与灌注管理策略。方法2007年1月至2012年4月使用达芬奇s（daVinci．S）机器人外科手术系统在PECC下完成心脏直视手术283例。采用Seldinger技术，在食道超声（TEE）引导下，经右侧股动脉、股静脉及颈内静脉插管建立体外循环（ECC）。ECC采用浅低温、中流量灌注，转流中使用负压辅助静脉引流（VAVD）装置辅助引流，连续血气监测系统（CDI500）监控血气及电解质变化。升主动脉阻断采用Chit．wood阻断技术，经升主动脉顺行灌注41含血冷停搏液（St．Thomas液）或康斯特液（HTK液）进行心肌保护。结果手术全部成功，ECC时间34—219（99．7±38．9）min，升主动脉阻断时间21—166（68．3±29．9）min，转流中尿液量50-2100（680．4±459．0）ml，超滤液量800-6700（2834．5±1121．1）ml，231例患者ECC液体总量为负平衡，负平衡量50～3100（860．3±569．1）ml，心脏自动复苏248例（88）；术后呼吸机辅助时间2～17（4．6±3．9）h，24h胸腔引流量15～630（167．8±76．6）ml。结论机器人辅助心脏手术采用PECC技术，安全可行。灌注中使用VAVD和CDI，手术团队间保持密切交流，是保证手术成功的重因素。
Objective To discuss the establishment and management of peripheral extracorporeal circulation （PECC） for ro- botically assisted cardiac surgery. Methods A total of 283 patients underwent cardiac surgery with da Vinci S robotic surgical system. PECC for most of patients was achieved with femoral arterial cannula, femoral venous cannula and right internal jugular venous cannula with the Seldinger guidewire method and transesophageal echocardiography （TEE） guidance. In all the cases, vacuum - assist venous drainage （VAVD） and continuous blood gas monitoring （CDI 500） were used during ECC. The aortic occlusion was performed with a Chitwood crossclamp and antegrade cardioplegia was delivered directly via chest with 4 ： 1 cold blood cardioplegic solution or HTK solu- tion for myocardial protection. Results ECC time and aortic cross - clump time was 34 - 219 （99.7 ± 38.9） min and 21 - 166 （68.3 ± 29.9） rain respectively. During ECC, the urine volume was 50 - 2100 （ 680.4 ± 459.0） ml, ultrafiltration volume was 800 - 6700 （2834.5±1121.1 ） ml and the total fluid balance was subzero - balanced or zero - balanced in 231 patients, the rate of auto - resusci- tation was 88%. Postoperative intubation time was 2 - 17 （4.6 ±3.9） h and drainage volume within 24 h postoperatively was 15 -630 （ 167.8 ± 76.6） ml. Conclusion The establishment of ECC system through peripheral vessels is feasible and safe. Using VAVD and CDI, keeping close communication between the surgical team are the key points of PECC for robotically assisted cardiac surgery.
出处
《中国体外循环杂志》
2013年第3期175-177,共3页
Chinese Journal of Extracorporeal Circulation
关键词
周围体外循环
机器人
负压辅助静脉引流
连续血气监测
Peripheral extracorporeal circulation
Robotics
Vacuum- assist venous drainage
Continuous blood gas monitoring
