半身体外循环技术在主动脉缩窄矫治术中的应用_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

张力 ,  周成斌 , 章晓华 , 陈寄梅 , 庄建

广东省心血管病研究所心外科广东省华南结构性心脏病重点实验室广东省人民医院广东省医学科学院（广州 510080）;

Corresponding author：

周成斌, Email: www.zcbwwww@163.com

Keywords：

主动脉缩窄; 半身体外循环; 脊髓保护

DOI：

10.7507/1007-4848.201802041

Video：

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目的探讨心脏不停跳下半身体外循环（partial cardiopulmonary bypass，PCB）在主动脉缩窄矫治术中的应用。方法回顾性分析 2016 年 3 月至 2017 年 8 月我院经左后外侧切口行缩窄主动脉段置换术 5 例男性主动脉缩窄患者的临床资料，平均年龄（22.80±14.22）岁。术中经降主动脉和左肺动脉分别插入动脉灌注管和静脉引流管，连接人工膜肺和滚轴泵，建立 PCB。采用心脏不停跳的方法，避免深低温（鼻咽温度 33℃ 以上），控制灌注流量在 15～50 ml/（kg·min），维持上肢血压 60～100 mm Hg 和下肢血压 50～80 mm Hg。结果 PCB 平均转流时间为（77.40±17.85）min，均平稳脱离体外循环。术后平均住 ICU 时间（25.00±14.17）h。所有患者无截瘫、肾损害等并发症。短期随访没有主动脉再狭窄现象。结论心脏不停跳下经降主动脉和左肺动脉插管建立 PCB 的技术在青少年或成人主动脉缩窄矫治术中安全、可行，能避免深低温及内脏和脊髓损伤。

Citation： 张力, 周成斌, 章晓华, 陈寄梅, 庄建. 半身体外循环技术在主动脉缩窄矫治术中的应用. 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.	杨超, 周钧, 杜玲, 等. 胸腹主动脉夹层手术脊髓损伤标记物临床研究. 中国实验诊断学, 2011, 15(7): 1143-1145.
12.	陈菲,邵涓涓,贾明,等. 全胸腹主动脉置换术后脊髓缺血的临床分析. 心肺血管病杂志, 2015, 34(9): 694-697.
13.	胡琳, 周诚, 陈剑锋, 等. 5 kg以下婴儿一期矫治主动脉缩窄合并心内畸形的体外循环管理. 华中科技大学学报(医学版), 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.	彭晓鹏,朱洪玉,林明,等. 外科治疗成人主动脉缩窄体外循环动脉灌注方案探讨. 数理医药学杂志, 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, 裴华伟, 等. 外科手术和介入技术治疗主动脉缩窄的meta分析. 心血管外科杂志(电子版), 2013, 2(2): 25-30.
7. 孙宏涛, 于存涛, 常谦, 等. 非体外循环下成人复杂型主动脉缩窄的解剖矫治. 中国胸心血管外科临床杂志, 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. 杨超, 周钧, 杜玲, 等. 胸腹主动脉夹层手术脊髓损伤标记物临床研究. 中国实验诊断学, 2011, 15(7): 1143-1145.
12. 陈菲,邵涓涓,贾明,等. 全胸腹主动脉置换术后脊髓缺血的临床分析. 心肺血管病杂志, 2015, 34(9): 694-697.
13. 胡琳, 周诚, 陈剑锋, 等. 5 kg以下婴儿一期矫治主动脉缩窄合并心内畸形的体外循环管理. 华中科技大学学报(医学版), 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. 彭晓鹏,朱洪玉,林明,等. 外科治疗成人主动脉缩窄体外循环动脉灌注方案探讨. 数理医药学杂志, 2016, 29(11): 1590-1592.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

半身体外循环技术在主动脉缩窄矫治术中的应用

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