中国体外循环杂志Issue(4)：223-226,4.DOI:10.13498/j.cnki.chin.j.ecc.2015.04.08
全电视胸腔镜下心脏手术的体外循环管理经验
The experience of cardiopulmonary bypass management in patients undergoing total videothoracoscopic cardiac surgery
邓丽 1张国伟 1杨慧 1李玲 1刘宏宇1
作者信息
- 1. 15000，哈尔滨，哈尔滨医科大学附属第一医院 心外科体外循环
- 折叠
摘要
Abstract
[ Abstract]:Objective To summarize the management of cardiopulmonary bypass( CPB) in patients undergoing surgery with to⁃tal video thoracoscope. Methods A retrospective analysis of 58 patients undergoing cardiac surgery with total video thoracoscope from March 2012 to Auguat 2014 was conducted. 17 patients were male, 41 patients were female. The patient age was 35.19±14.51 years and weight was 57.64±11.47 kg. Twenty eight(48.27%)patients of atrial septal defect, 12(20.69%)patients of atrial septal defect and tricuspid valvuloplasty, 12(20.69%)patients of left atrial myxoma, 1(1.73%)patients of right atarial tumor, 1(1.73%)patient of par⁃tial atrioventricular canal defect, 3(5.17%)patients of atrial septal defect and pulmonary stenosis, 1(1.72%)patient of atrial septal defect and unroofed coronary sinus received surgery. The arterial catheter was placed in the right femoral vein, the venous catheter was placed in the superior vena cava to set up CPB. Middle–hypothermia, middle-hemodilution, middle-high flow rate perfusion were used during the CPB, the myocardium was protected by coronary perfusion with 4:1 cold oxygenated blood. Aortic corss-clamping was performed in 56 pantients and 2 patients had beating heart surgery. Results Cardiopulmonary bypass time ranged form 65 min to 178 min with a mean of 108.83±24.73 (min). Aortic cross-clamp time ranged from 20 min to 78 min with a mean of 52.46±17.29 (min). Fifty six patients had spontaneous cardiac rhythm recovery whereas 2 patients had ventricular fibrillation and recovery sinus rhythm by electric defibrillation. Four patients experienced inadequate venous drainage, and superior vena cava ( SVC) cannulation had to be per⁃formed to facilitate blood drainage.Three patients had excessively high femoral pressure and the left femoral artery cannula was required. Vascular injury happened in two cases from difficulty in removal of femoral artery cannulae fromone patient and piercing of the femoral artery by the guiding wire. The mechanical ventilation time was 6.13±2.33(h)andthe time of stay in ICU was 21.05±4.35(h). Thechest tube drainage was 142.07±52.07(mL).No complications was noted and all patients were cured and discharged. Conclusion It is very important to choose suitable cannula type and make sure they are put in the right way. Effective drainage and perfusion and good communication between surgeons and perfusionistsare also very important for the successful management of CPB for total videothoraco⁃scopic cardiac surgery.关键词
电视胸腔镜/体外循环/管理经验Key words
Thoracoscopy/Cardioplumonary bypass/Mangement experience引用本文复制引用
邓丽,张国伟,杨慧,李玲,刘宏宇..全电视胸腔镜下心脏手术的体外循环管理经验[J].中国体外循环杂志,2015,(4):223-226,4.
