摘要
目的探讨急诊体外循环在抢救心血管危重患者中的重要价值。方法2003年1月-2011年2月应用急诊体外循环抢救危重患者21例，3例使用鼓泡氧合器，18例使用膜肺。预充液：早期以乳酸林格液＋白蛋白为主，后期采用勃迈力A、万汶＋白蛋白为主。对于急性大出血病例可在安装机器时首先安装心内血液回收系统。以便全身肝素化后回收失血。2例采用常温左心辅助转流，16例采用亚低温、中高流量转流，3例采用中度低温、中高流量转流。主动脉一上下腔静脉转流18例，左房、股动脉转流3例。术中采用4：1温血间断灌注，顺灌＋逆灌等多种心肌保护方法。综合应用超滤、零平衡超滤和改良超滤。结果全组建立体外循环时间5-15min，体外循环时间56-186min，主动脉阻断时间32-135min，主动脉开放后心脏自动复跳17例，自动复跳率89％。21例中存活19例，存活率90．5％，死亡2例，其中1例采用主动脉内球囊反搏协助停机2d后死亡，1例法洛四联征心内纠治术后死于低心排综合征。结论心血管危重患者急诊体外循环应用亚低温，应用膜肺，增加胶体预充及调整预充液成分，加强心肌保护，应用超滤和改良超滤技术等综合急诊体外循环管理措施，有利于提高手术疗效，减少术后并发症的发生。
Abstract： [ Objective ] To evaluate the value of emergency extracorporeal circulation on salvage of patients who suffering from critical cardiovascular disease. [Methods] From Jan 2003 to Feb 2011, 21 patients who suffered from critical cardiovascular disease were salvaged with emergency extracorporeal circulation, 3 with bubbling oxygenators and 18 with membrane oxygenators. We used lactic acid-Ringer＇s solution and albumin in prophase and use acetic acid-Ringer＇s solution, Voluven and albumin in anaphase as the main component of priming fluid. For patients suf- fered from acute bleeding, the blood recovery system was assembled firstly so as to retrieve the lost blood. Left ven- tricle assistance bypass with common temperature was use in 2 patients, moderate to high speed bypass with sub-hy- pothermia in 16 patients, and with moderate hypothermia in 3patients. Aorta-Venae Cavae bypass was used in 18 patients and left atrium- femoral artery bypass in 3 patients. Intermittent warm blood （4：1） perfusion through direct or retrograde coronary circulation was performed as method of myocardial preservation. Uhrafihration, zero-balance uhrafiltration and modified ultrafiltration were used during or after the procedure of emergency extracorporeal circu- lation. [Results] The set up time of emergency extracorporeal circulation from 5 to 15 minutes, extraeorporeal circu- lation time from 56 to 186 minutes, and cross clamping time from 32 to 135 minutes. Heartbeat self-recovery oc- curred in 17 patients （89%） when cross clamping was terminated. 19 patients survived （survival rate was 90.5%）. 1 patient was treatment with intra-aortic balloon eounterpulsation and died in 2 days after stop the counterpulsation, 1 patient suffered from tetralogy of Fallot succumbed to low heart stroke syndrome. [ Conclusion ] Emergency extracor- poreal circulation with membrane oxygenator and sub-hypothermia is high-performance on salvage of patients whosuffering from critical cardiovascular disease. Synthesizing extracorpor
出处
《中国现代医学杂志》
CAS
CSCD
北大核心
2012年第6期96-98,共3页
China Journal of Modern Medicine
关键词
急诊体外循环
心血管危重患者
emergency extracorporeal circulation
critical cardiovascular disease
