胸腔镜下二尖瓣手术的体外循环管理（附80例报告）

Extracorporeal circulation management of 80 patients underwent mitral valve surgery by video-assisted thoracoscopy

摘要:

摘要：目的??总结胸腔镜下二尖瓣心脏外科手术的体外循环（CPB）管理经验和方法。方法?2013年1月-2017年6月80例胸腔镜下二尖瓣置换术，CPB采用中、浅低温，全部采用股动静脉插管，并在CPB中予以负压辅助静脉吸引，术中全部采用HTK液灌注心肌予以心肌保护，对CPB建立方法、CPB过程及手术后结果进行评价。结果?80例心脏二尖瓣疾病患者全部予以痊愈出院。全部患者CPB转流时间为97～308（192.2±54.2）min；升主动脉阻断时间为50～233（130.8±46.9）min；辅助转流时间为30～53（41.8± 8.1）min。术后呼吸辅助时间6～24（20.6±14.1）h；术后ICU时间为2～6（3.3±2.6）d；术后住院时间7～10?d；术中及术后无股动静脉插管相关并发症，患者术后均恢复良好，脱机良好，无严重并发症。出院随访时间3～12个月，结果满意。结论?胸腔镜下二尖瓣手术中，CPB方法安全、可行，开展此手术的初期CPB时间和主动脉阻断时间较传统手术时间较长，应加强CPB的管理，避免术中术后产生CPB相关性并发症。

Abstract:

Abstract: Objective?To summarize the experience of the management and method in cardiopulmonary bypass (CPB) with mitral valve surgery by video-assisted thoracoscopy.?Methods?From January 2013 to June 2017, the clinical data of 80 patients underwent mitral vavle replacement by video-assisted thoracoscopic were reviewed and analyzed. Mild and moderate hypothermia were used in cardiopulmonary bypass (CPB). CPB cannulas of all the patients were established through femoral artery and vein. Vacuum-assisted venous drainage were implemented during the CPB. Myocardial protection of all the patients in operation was accomplished with HTK solution. The CPB established methods, CPB process and postoperative results of all the patients underwent operation by video-assisted thoracoscopy were analyzed.?Results?80 patients of the mitral valve disease were all recovered and discharged. The CPB time was 97?~?308 min (192.2?±?54.2)?min. The aortic cross-clamping time was 50~233?min (130.8?±?46.9)?min. The aortic declamping time was 30~53 min (41.8?±?8.1)?min. The post-operation respiratory auxiliary time was 6?~?24?h (20.6?±?14.1)?h. The post-operation ICU duration was 2?~?6 d (3.3?±?2.6)?d. The post-operation hospitalization duration was 7?~?10 d. All the patients recovered well and discharged uneventfully. And all the patients were followed up for 3?~?12 months. The clinical effects are satisfactory.?Conclusion?The CPB in the mitral valve surgery by video-assisted thoracoscopy is sate and feasible. But it should be modified to shorten the duration of CPB and aorta clamping. The various complications of intraoperation and post-operation should be avoided by the management of CPB.