摘要
目的总结胸腔镜再次心脏瓣膜手术的体外循环管理经验。方法回顾分析2012年1月至2014年12月我院行胸腔镜再次心脏瓣膜手术患者的体外循环及围术期资料。所有患者采用全身麻醉,经皮上腔静脉插管联合股动静脉插管建立外周体外循环,不阻断升主动脉维持心脏跳动或室颤状态在胸腔镜下完成手术。结果全组患者25例,其中再次二尖瓣置换术11例、同期三尖瓣成形术2例及左房血栓清除术1例;再次三尖瓣置换术10例;再次三尖瓣成形术4例。手术时间1.8-9.5 h[（3.3±1.6）h],体外循环时间37.0-154.0 min[（96.5±26.9）min],最低体温（32.4±1.5）℃。20例患者心脏跳动下完成手术,5例患者室颤下完成手术。全组患者发生围术期并发症6例（24.0%）,术后院内死亡3例（12.0%）。结论胸腔镜下再次瓣膜手术能够在外周体外循环主动脉不阻断技术支持下实施,体外循环管理的重点在于维持充分的静脉引流和灌注流量,注意心脏和大脑等重要脏器的保护。
Objective To summarize the experiences of cardiopulmonary bypass management for thoracoscopic cardiac valvular reoperation. Methods The cardiopulmonary bypass and perioperative data of patients undergone thoracoscopic cardiac valvular reoperation from January 2012 to December 2014 were reviewed retrospectively. General anesthesia was performed in all patients. The peripheral cardiopulmonary bypass was set up through femoral arterial and venous cannulation and percutaneous superior vena cava cannulation. All operations were performed under thgracoscopy with heart-beating or ventricular fibrillation by avoiding aortic cross-clamping. Results Of the 25 patients studied, 11 had the second mitral valve replacement in which 2 had simultaneous tricuspid valve plasty and 1 had left atrial thromblus removal, 10 patients underwent the second tricuspid valve replacement and 4 had the second tricuspid valve plasty. The mean operation time was 3.3 ± 1.6 h （ 1.8 ± 9. 5 h）. The mean cardiopulmonary bypass time was （96. 5 ± 26.9 ） min （37. 0 ± 154.0 min）. The mean lowest body temperature was （32.4 ± 1.5）℃. There were 20 patients who had undergone surgery with heart beating, and 5 patients who had undergone surgery with ventricular fibrillation. There were 6 patients with perioperative complications （24. 0% ） and 6 died （ 12. 0% ）. Conclusion The cardiac valvular reoperation with thoracoscopy can be performed under peripheral cardiopulmonary bypass without aortic cross-clamping. The key points of cardiopulmonary bypass management include the maintainability of enough venous drainage and perfusion flow, and the protection of heart, brain and other important organs.
出处
《实用医院临床杂志》
2016年第1期16-19,共4页
Practical Journal of Clinical Medicine
基金
广东省医学科研基金资助项目(编号:A2015417)
关键词
体外循环
心肌保护
微创外科
再次心脏手术
Cardiopulmoanry bypass
Myocardial protection
Minimally invasive surgery
Cardiac reoperation
