半身體外循環技術在主動脈縮窄矯治術中的應用_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

張力 ,  周成斌 , 章曉華 , 陳寄梅 , 莊建

廣東省心血管病研究所心外科廣東省華南結構性心臟病重點實驗室廣東省人民醫院廣東省醫學科學院（廣州 ?510080）;

Corresponding?author：

周成斌, Email: www.zcbwwww@163.com

Keywords：

主動脈縮窄; 半身體外循環; 脊髓保護

DOI：

10.7507/1007-4848.201802041

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目的探討心臟不停跳下半身體外循環（partial cardiopulmonary bypass，PCB）在主動脈縮窄矯治術中的應用。方法回顧性分析 2016 年 3 月至 2017 年 8 月我院經左后外側切口行縮窄主動脈段置換術 5 例男性主動脈縮窄患者的臨床資料，平均年齡（22.80±14.22）歲。術中經降主動脈和左肺動脈分別插入動脈灌注管和靜脈引流管，連接人工膜肺和滾軸泵，建立 PCB。采用心臟不停跳的方法，避免深低溫（鼻咽溫度 33℃ 以上），控制灌注流量在 15～50 ml/（kg·min），維持上肢血壓 60～100 mm Hg 和下肢血壓 50～80 mm Hg。結果 PCB 平均轉流時間為（77.40±17.85）min，均平穩脫離體外循環。術后平均住 ICU 時間（25.00±14.17）h。所有患者無截癱、腎損害等并發癥。短期隨訪沒有主動脈再狹窄現象。結論心臟不停跳下經降主動脈和左肺動脈插管建立 PCB 的技術在青少年或成人主動脈縮窄矯治術中安全、可行，能避免深低溫及內臟和脊髓損傷。

Citation： 張力, 周成斌, 章曉華, 陳寄梅, 莊建. 半身體外循環技術在主動脈縮窄矯治術中的應用. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(9): 814-816. doi: 10.7507/1007-4848.201802041 Copy

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10.	Svensson LG. New and future approaches for spinal cord protection. Semin Thorac Cardiovasc Surg, 1997, 9(3): 206-221.
11.	楊超, 周鈞, 杜玲, 等. 胸腹主動脈夾層手術脊髓損傷標記物臨床研究. 中國實驗診斷學, 2011, 15(7): 1143-1145.
12.	陳菲,邵涓涓,賈明,等. 全胸腹主動脈置換術后脊髓缺血的臨床分析. 心肺血管病雜志, 2015, 34(9): 694-697.
13.	胡琳, 周誠, 陳劍鋒, 等. 5 kg以下嬰兒一期矯治主動脈縮窄合并心內畸形的體外循環管理. 華中科技大學學報(醫學版), 2013, 42(2): 234-236.
14.	Okamura T, Ishibashi N, Kumar TS, et al. Hypothermic circulatory arrest increases permeability of the blood brain barrier in watershed areas. Ann Thorac Surg, 2010, 90(6): 2001-2008.
15.	Chen H, Zhang H, Hong H, et al. Outcome of continuous cerebral and myocardial perfusion under mild hypothermia for aortic coarctation with ventricular septal defect repair. J Card Surg, 2013, 28(1): 64-69.
16.	彭曉鵬,朱洪玉,林明,等. 外科治療成人主動脈縮窄體外循環動脈灌注方案探討. 數理醫藥學雜志, 2016, 29(11): 1590-1592.

1. Kanter KR, Vincent RN, Fyfe DA. Reverse subclavian flap repair of hypoplastic transverse aorta in infancy. Ann Thorac Surg, 2001, 71(5): 1530-1536.
2. Baumgartner H, Bonhoeffer P, De Groot NM, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J, 2010, 31(23): 2915-2957.
3. Feltes TF, Bacha E, Beekman RH 3rd, et al. Indications for cardiac catheterization and intervention in pediatric cardiac disease: a scientific statement from the American Heart Association. Circulation, 2011, 123(22): 2607-2652.
4. Sandrio S, Karck M, Gorenflo M, et al. Results of using cardiopulmonary bypass for spinal cord protection during surgical repair of complex aortic coarctation. Cardiol Young, 2014, 24(1): 113-119.
5. Jurcut R, Daraban AM, Lorber A, et al. Coarctation of the aorta in adults: what is the best treatment? Case report and literature review. J Med Life, 2011, 4(2): 189-195.
6. 蒙延海, 田川, 裴華偉, 等. 外科手術和介入技術治療主動脈縮窄的meta分析. 心血管外科雜志(電子版), 2013, 2(2): 25-30.
7. 孫宏濤, 于存濤, 常謙, 等. 非體外循環下成人復雜型主動脈縮窄的解剖矯治. 中國胸心血管外科臨床雜志, 2011, 18(3): 214-217.
8. Dave H, Rosser B, Reineke K, et al. Aortic arch enlargement and coarctation repair through a left thoracotomy: significance of ductal perfusion. Eur J Cardiothorac Surg, 2012, 41(4): 906-912.
9. Brudney CS, Gosling P, Manji M. Pulmonary and renal function following cardiopulmonary bypass is associated with systemic capillary leak. J Cardiothorac Vasc Anesth, 2005, 19(2): 188-192.
10. Svensson LG. New and future approaches for spinal cord protection. Semin Thorac Cardiovasc Surg, 1997, 9(3): 206-221.
11. 楊超, 周鈞, 杜玲, 等. 胸腹主動脈夾層手術脊髓損傷標記物臨床研究. 中國實驗診斷學, 2011, 15(7): 1143-1145.
12. 陳菲,邵涓涓,賈明,等. 全胸腹主動脈置換術后脊髓缺血的臨床分析. 心肺血管病雜志, 2015, 34(9): 694-697.
13. 胡琳, 周誠, 陳劍鋒, 等. 5 kg以下嬰兒一期矯治主動脈縮窄合并心內畸形的體外循環管理. 華中科技大學學報(醫學版), 2013, 42(2): 234-236.
14. Okamura T, Ishibashi N, Kumar TS, et al. Hypothermic circulatory arrest increases permeability of the blood brain barrier in watershed areas. Ann Thorac Surg, 2010, 90(6): 2001-2008.
15. Chen H, Zhang H, Hong H, et al. Outcome of continuous cerebral and myocardial perfusion under mild hypothermia for aortic coarctation with ventricular septal defect repair. J Card Surg, 2013, 28(1): 64-69.
16. 彭曉鵬,朱洪玉,林明,等. 外科治療成人主動脈縮窄體外循環動脈灌注方案探討. 數理醫藥學雜志, 2016, 29(11): 1590-1592.

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