心内直视手术中七十岁以上患者的体外循环管理

目的总结分析心内直视手术中七十岁以上患者的体外循环特点和管理方法。方法 2005年3月至2008年7月间7000余例手术中70岁以上患者共有194例,分类进行心内直视手术。体外循环时全部应用进口膜肺,勃脉力A和胶体预充,常规加入白蛋白、激素和乌司他丁;心肌保护采用间断灌注4：1冷含血停搏液,顺灌逆灌和桥灌相结合;常规监测混合静脉氧饱和度和血细胞压积,积极应用超滤技术。结果术中转流平稳,血流动力学稳定,监测指标均在正常范围,平均体外循环时间和主动脉阻断时间分别为111.5±40.4m in和63.6±21.0m in,自动复跳率52.6%,平均搭桥数目3.4±0.8支,术后平均气管拔管时间24.0±12.7h,平均ICU时间4.7±3.5d。结论 70岁以上患者以瓣膜和冠状动脉病变为主、病变复杂,体外循环时间和主动脉阻断时间较长,各脏器保护要求高,针对高龄患者的特点,制定相应的体外循环管理方法,是保证手术成功的重要因素。

The Cardiopulmonary Bypass Management of Patients Over Seventy Years Old Undergoing Open Heart Operations

Objective To summarize the characteristic and management of cardiopulmonary bypass（CPB） over seventy years old.Methods From March 2005 to July 2008,over 7000 patients underwent cardiac operations in our hospital.Among these patients,194 patients（127 male,67 female） were over seventy years old（71-83yrs,mean73.4±1.7yrs）.Membranous oxygenater was used in every CPB.All patients were given plasmalyte-a,colloid,album and sou-medrol in CPB prime.Myocardial protection performed used cold blood cardioplegia.Antrograde combined with retrograde coronary sinus and coronary arterial graft cadioplegia perfusion were used.Ultrafiltration technique were actively used during CPB.Results It was well-balanced and stably in CPB.Among these patients,the mean CPB time was 111.5±40.4mins,the mean aortic-crossed time was 63.6±21.0mins,the ratio of self-beating was 52.6%,the average number of arterial graft was 3.4±0.8,the average tube-drawing time was 24.0±12.7hrs,the average ICU stay was 4.7±3.5days.Conclusion The pathological changes of patients over seventy years old were mostly concerned with heart vavle and coronary artery.The state of an illness was generally serious.The time of CPB was frequently long.Therefore,the well organs protection and CPB management was the key of surgical operation success.