| 摘要: |
| ［摘要］ 目的 探讨采用中低温体外循环经冠状静脉窦持续逆行灌注自体氧合机血的方法，进行双瓣膜置换术加改良迷宫术的临床效果。方法 全组27例均在低温体外循环心内直视下施行手术。鼻咽温度降至中低温（26～27 ℃）维持，术中阻断升主动脉并经冠状静脉窦持续逆行灌注，通过压力和容量控制的冠状静脉窦灌注氧合机血，不使用心脏停搏液；完成心内主要操作后复温，心脏手术完毕即可停机。结果 27例全部存活，术中出血量少，未发生严重的房室传导阻滞及脑栓塞。随访4～26个月，其中22例维持窦性心律，心房颤动复发3例，偶发房扑2例，经服用乙胺碘呋酮后恢复窦性心律。结论 中低温体外循环经冠状静脉窦持续逆行灌注下的双瓣膜置换加改良迷宫术操作简单，疗效确切，历时缩短，安全性高。 |
| 关键词: 心肌保护 双瓣膜置换术 慢性心房颤动 迷宫手术 |
| DOI：10.3969/j.issn.1674-3806.2012.10.13 |
| 分类号:R 54 |
| 基金项目: |
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| Clinical application of continuous retrograde myocardial perfusion in the double valve replacement plus improved maze procedure |
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LUO You-qiao, FANG Hai-ning, TAN Wei,et al.
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Department of Cardiac Surgery, the Third People′s Hospital of Nanning, Guangxi 530003,China
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| Abstract: |
| ［Abstract］ Objective To explore the clinical effect of continuous retrograde coronary sinus perfusion of autologous blood from oxygenation machine under middle hypothermia during double valve replacement plus maze procedure.Methods All 27 patients underwent open heart surgery under hypothermic cardiopulmonary bypass. Nasopharyngeal temperature was dropped to the middle and low temperature (26～27 ℃) and was maintained intraoperative block of the ascending aorta and coronary sinus retrograde continued perfusion was performed,pressure and volume of the coronary sinus perfusion blood from oxygenation machine was controlled,did not use the heart cardioplegia；after major heart operation completion, rewarming was performed, after heart surgery was completed can be stop.Results Twenty-seven patients all survived,follow-up was performed for 4 to 26 months; sinus rhythm was maintained in 22 patients, atrial fibrillation recurrence in 3, occasional atrial flutter in 2, whose sinus rhythm restored after taking amiodarone. Bleeding was less in operation,and no severe atrioventricular block and cerebral embolism occured.Conclusion Double valve replacement plus improved maze procedure through continuous coronary sinus retrograde perfusion under middle hypothermia cardiopulmonary bypass has advantages of simple operation, exact effect, shorter duration, high security. |
| Key words: Myocardial protection Double valve replacement Chronic atrial fibrillation Maze procedure |
