浅低温心脏不停跳技术在重症心脏瓣膜病瓣膜替换手术中的应用.docVIP

精品论文 参考文献 浅低温心脏不停跳技术在重症心脏瓣膜病瓣膜替换手术中的应用 宿学家1 张慧颖3 张志勇1 范波1 林庆录2 李松龄1 　　（1解放军第88医院心胸外科 271000；2解放军第88医院麻醉科 271000） 　　（3泰安军分区干休一所 山东泰安 271000） 　　【摘要】目的 总结浅低温心脏不停跳技术在重症心脏瓣膜病患者瓣膜替换手术中应用临床体会。方法 132例重症心脏瓣膜病患者在浅低温体外循环心脏不停跳下行人工瓣膜替换术。其中二尖瓣替换78例，主动脉瓣替换34例，双瓣膜替换18例，三瓣膜替换2例。所有病例中需要同期行CABG 12例。结果 全组手术死亡2例，死亡率为1.5%。并发症包括：低心排综合症4例，应用IABP辅助2例，死亡1例。急性肾功能衰竭1例，经肾替代治疗无好转后死亡。肺部感染5例，经抗炎治疗后痊愈。手术切口感染7例，经加强换药治疗后痊愈。无气栓发生，无呼吸衰竭及消化道出血。血红蛋白尿23例，发生率17%，经碱化尿液治疗后痊愈。结论 浅低温心脏不停跳下行瓣膜替换有较好的心肌及其他重要脏器保护作用，能减少病死率及并发症的发生，尤其适应于重症瓣膜病患者。 　　【关键词】浅低温 心脏不停跳 重症瓣膜病 人工瓣膜替换术 　　【中图分类号】R654.2 【文献标识码】A 【文章编号】2095-1752（2014）13-0015-02 　　Experience of cardiac valve replacement in serious patients by beating heart CPB on light hypothermia.SU xue-jia1, ZHANG hui-ying3,FAN bo1,LING qing-lu2,LI song-ling2.11. Department of Cardio-Thoracic Surgery of 88 Hospital,PLA. 2. Department of Anesthesiology, 88 Hospital PLA.3 Sanatorium of Tairsquo;an Military Subarea.Shandong Taian,271000 　　【Abstract】 Objective: To summarize the clinical experience of cardiac valve replacement in serious patients by beating heart CPB (cardiac pulmonary bypass) on light hypothermia.Method:Valve replacements were performed in 132 serious cardiac valvular cases by beating heart CPB on light hypothermia from August 2000 to January 2014.Mitral valve replacement 78 cases,Aortic valve replacement 34 cases,Double valves replacement 18 cases,Three vavles replacement 3 cases and coronary artery bypass grafting in 12cases. Result:The early death was 2 cases,the mortality was 1.5%. Low cardiac output was 4 cases,2 cases were assistanted by IABP and 1 cases was dead.Acute renal failure was 1cases who was dead after treated by CRRT. Pneumonia was 5 cases and healed by antibiotics therapy. Surgicl site infection was 7 cases and healed by changed dressings therapy.Non air embolism、respiratory failure and alimentary tract hemorrhage happened. Hemoglobinuria was 23 cases(17%) and healed by alkalized