摘要
目的探讨延长辅助循环时间对危重心脏患者复苏的影响。方法选取30例危重患者行体外循环下冠脉搭桥手术及瓣膜置换手术,采用心脏复跳后延长辅助循环时间的处理方法。体外循环使用TERUM O SYSTER I型机。采用浅低温(33℃￣35℃),中高流量(2.0￣2.4 L/m in.m 2)灌注。心肌保护采用血液晶体4∶1停跳液,先温后冷顺行灌注。首量灌注停跳液后,无心电活动则不作二次灌注。灌注压力维持在60￣100 m m H g。结果 6例行搏动灌注,出现血红蛋白尿3例,普通超滤22例,全组心脏自动复跳23例,电击复跳7例。29例顺利脱机,28例痊愈出院。结论随着体外循环技术的不断提高,体外循环设备的不断完善,辅助时间的延长是安全的。对冠心病和瓣膜病患者合并其他病变使病情危重的患者,体外循环是一个重要的保障。这有利于使心肌得到充分休息,偿还氧债,为顺利脱机创造有利条件,从而减少了术后对ECM O的依赖。
Objective To discuss the influence of extending the auxiliary cycle time on the recovery of patients with critical heart disease.Methods 30 patients were treated coronary artery bypass surgery under cardiopulmonary bypass and valve replacement surgery,and weretreatment with the method of extending the auxiliary cycle time after heart resuscitation.Cardiopulmonary bypass used TERUMO SYSTER I Machine.Make a perfusion using mild hypothermia（33℃～35℃） and high flow（2.0～2.4 L/min·m2）.Myocardial protection used cardioplegia with the ratio of 4∶1,and made antegrade perfusion.After the first volume of perfusing cardioplegia,no cardiac electrical activity was not regarded as second perfusion.Perfusion pressure maintains in 60～100 mmHg.Results 6 patients were treated pulsatile perfusion.And 3 patients appeared hemoglobinuria,22 patiets were taken general ultrafiltration,23 patients appeared automatic cardiac resuscitation,and 7 appeared shock resuscitation.Conclusion With the advancemet of cardiopulmonary bypass techniques and the improvement of cardiopulmonary bypass equipment,extending the auxiliary cycle time is safe.For the severe patients with coronary heart disease and valvular disease combined with other complications,cardiopulmonary bypass is an important safeguard,which is helpful to makemyocardium get enough rest and oxygen debt repayment,to create favorable conditions for successfully off-line andreduce the dependence ECMO postoperatively.
出处
《透析与人工器官》
2011年第1期25-27,共3页
Chinese Journal of Dialysis and Artificial Organs
关键词
辅助循环
危重心脏病患者
复苏
the auxiliary cycle
patients with critical heart disease
recovery
