体外循环长时间转流535例临床估价

目的：介绍长时间体外循环管理的方法和经验。方法：我院自1984年至1995年12月共施行体外循环时间超过120分钟的心脏直视手术535例，其中男性345例，女性190例；年龄3～71岁．体表面积0．55～2．2平方米。双瓣替换术151例．二尖瓣替换术113例，法乐氏四联症107例，冠状动脉旁路移植术62例，主动脉瓣替换术30例．复杂畸形25例．其它47例。全组病例均采用中深度低温及中深度血液稀释，心肌保护采用灌注含钾冷停跳液。复跳后．适当延长辅助循环时间。术中采用血液超滤法，并尽可能采用搏动性血流，以确保重要脏器有充沛的血供。结果：全组病例中．体外循环时间为70～214分钟，心脏停跳时间72～230分钟。术中自动复跳209例．自动复跳率占39％。结论：在长时间体外循环心脏直视手术中．综合应用上述措施．可显著提高体外循环质量．增加手术成功率。

Clinical Estimation on 535 Patients of Prolonged Cardiepulmonary Bypass

Objective: To report the experience of prolonged cardiopulmonary bypass (CPB). Clnical materials and methods: From Jan. 1984 to Dec 1995, there were 535 patients with prolonged CPB in Shanghai Chest Hospital. They included 345 males and 190 fe-malses. Their age ranged from 3 to 71 years old and body weighed 11~86 kg. There were 151 mitral and aortic bivalvalar replacements, 113 mitral valve replacements, 62 coronary artery bypass graftings, 30 aortic valve replacements and 179 other -surgeries. Results; The CPB peiods of these cases were all over 120 minutes (ranged from 120 to 548 minutes). The aortas were cross clamped for 90 - 214 minutes. The hearts were arrested for 92 - 230 minutes. During operation, the mean artery blood presure (AMP) maintained 6. 8-12 kPa and the central vein blood pressure maintained 0~1. 37 kPa. 209 patients' hearts were cardiac spontaneous defibrillation during bypass. The cardiac spontaneous defibrillation rate was 39%. 33 patients died. But they were not-related to the perfusion. Conclusion: In order to gain good myocardiac protection during prolonged CPB, the follows were important: (1) Keep high flow rate perfusing and high AMP; (2) Maintain hemotorit between 15% and 20% ; (3) Use good pump and oxygenator such as palsatile pump and membrane oxygenaton (4) Prolong the time of assistant circulation. They were helpful to increase the success rate of open heart surgery with prolonged cardiopulmonary bypass.