摘要
目的总结全胸腔镜心脏手术体外循环（ECC）管理特点。方法 2013年1月至2014年6月开展123例全胸腔镜心脏手术,其中男性41例,女性82例。经颈内静脉和股静脉插静脉引流管,使用负压辅助静脉引流（VAVD）技术。右侧股动脉插动脉灌注管,逆行灌注全身。ECC过程中采用中低温（28～32℃）,灌注流量为60～80 ml/（kg·min）。心肌保护采用经主动脉根部顺行灌注冷血心肌保护液的方法。结果 ECC平均时间为（117.2±41.8）min,平均主动脉阻断时间为（73.7±32.1）min。所有病例均在开放升主动脉后心脏自动复跳。术后平均呼吸机辅助时间（13.2±12.7）h,术后第一天平均胸液量（43.5±74.1）ml,没有明显神经系统并发症,平均ICU时间（34.6±32.7）h。结论全胸腔镜心脏手术经外周血管插管,逆行灌注,辅以VAVD技术可改善静脉引流,其体外循环管理和心肌保护方法与常规体外循环管理类似。
Objective To summarize the management of extracorporeal circulation（ ECC） during totally thoracoscopic cardiac operation. Methods From January 2013 to June 2014,123 patients（ 41 males and 82 females） underwent totally thoracoscopic cardiac operation. The venous cannulas were inserted into the internal jugular vein and femoral vein. The vacuum assisted venous drainage（ VAVD） technology was used for enhancing the venous drainage. The arterial cannula was inserted to the right femoral artery for retrograde perfusion. The flow of ECC was about 60-80 ml /（ kg·min） under moderate hypothermia（ 28-32℃）. Antegradecold blood cardioplegia was delivered via the arotic root. Results The average ECC duration was 117. 2 ± 41. 8 min and the average aortic cross-clamp time was 73. 7±32. 1 min. All patients restored heartrhythm spontaneously after release of cross-clamp. The post-operative ventilation time was 13. 2±12. 7 h and the average thoracic drainage volume was 43. 5±74. 1 ml at first post-operative day. There was no obvious neurological complication. The average ICU stay was 34. 6±32. 7 h. Conclusion ECC during the totally thoracoscopic cardiac operation can be established via the peripheral vascular cannulation with the supplement of VAVD support for the venous drainage and provide retrograde perfusion to the whole body. The management of ECC and myocardial protection in these cases are similar with that of conventional management.
出处
《中国体外循环杂志》
2015年第1期47-49,共3页
Chinese Journal of Extracorporeal Circulation
基金
"十二五"国家科技支撑计划课题((2012Y003)
关键词
全胸腔镜
心脏手术
体外循环
Totally thoracoscopic cardiac operation
Cardiac surgery
Extracorporeal circulation
