摘要
目的探讨浅低温体外循环下心脏跳动中二尖瓣置换术的临床应用效果。方法2001年10月至2008年11月，采用浅低温、不阻断主动脉、不灌注心脏停跳液、心脏跳动下行二尖瓣置换术156例。结果全组患者均顺利完成手术。体外循环时间（75．2±16.3）min，上、下腔静脉阻断时间（573±13．5）min，呼吸机辅助时间（10．1±5．5）h，术后并发血红蛋白尿11例、低心排综合征9例、灌注肺3例。住院死亡2例，死亡原因为低心排综合征1例、室颤1例。随访2～82个月，术后抗凝不当脑栓塞2例，无晚期死亡。结论浅低温体外循环下心脏跳动中行二尖瓣置换术是一种接近生理状态的心肌保护方法，能减轻心肌缺血和再灌注损害，既缩短了手术操作时间，简单安全易行，又利于临床推广应用。
Objective To explore the effects of mitral valve replacement on beating heart under mild hypothermia. Methods From Oct.2001 to Nov 2008, mitral valve replacements on beating heart were performed on 156 patients under the conditions such as the mild hypothermia, without cross clamping aorta and perfusing cardioplegic solution. Results All patients underwent the operations prosperously. The average time of extracorporeal circulation, caval veins cross clamping and mechanical ventilation were （75.2±16.3）min, （57.3±13.5）min and （10.1±5.5）h respectively. The postoperative complication consisted of hemoglobinuria in 11 patients, low cardiac output syndrome in 9, perfusion lung in 3. Two patients died, the causes of death included low cardiac output syndrome in 1 cases, ventricular fibrillation in 1. During the period of follow-up of 2-82 months, 2 cases suffered from cerebral embolism owing to improper anticoagulation, no one died at advanced stage. Conclusion The mitral valve replacement with beating heart under mild hypothennia is a good myocardial protective method closed to physiological condition, which may be attributed to the reduction of ischemic-reperfusion injury. The clinical effects are complementary, not only have the merits of simple, safe, feasible and short operation time, but also have worths of clinical expansion.
出处
《中国心血管病研究》
CAS
2010年第1期12-14,共3页
Chinese Journal of Cardiovascular Research
关键词
心内直视术
心脏跳动
心肌保护
二尖瓣置换术
Open heart operation
Beating heart
Myocardial protective
Mitral valve replacement
