浅低温体外循环与心脏跳动中的瓣膜置换手术

广西医科大学第一附属医院心胸外科何巍中低温体外循环心停跳深低温停循环心停跳浅低温体外循环心不停跳每降低1℃代谢率↓6～7%37℃～32±1℃代谢率↓24～35%体温（℃）代谢率（%）36.810031.875～8030.060～7026.85020.02516.82015.015温度与代谢率的关系温度升高，氧离曲线右移，促使O2释放，温度降低，不利于O2的释放。血液温度降低能同时使血红蛋白对O2的亲和力上升，不利于O2的释放32±1℃时氧离曲线右移，O2的释放正常。空跳的心脏代谢氧耗量↓45～70%左右氧合动脉血的机体循环和冠状循环维持了机体和心脏的代谢和氧耗。顺灌法山羊左心室心肌超微结构变化情况顺灌法山羊左心室心肌超微结构变化情况CPB120minCPB150min实验组对照组实验组对照组细胞核－－－－线粒体－+－++肌原纤维－－－－细胞膜－－－+内皮水肿－－－+间质水肿－+－++糖原颗粒减少－+－++－：无明显变化；+：轻度改变；++：中度改变；+++：重度改变1.1临床资料逆行灌注示意图2结果

换瓣前换瓣后3讨论作者例数早期死亡率(%)杂志Houser4910.2ConnMedBojar

527.7AnnThoracSurgDaenen6476.8JThoracCardiovascSurgAranki7176.6CirculationElayda17117.5CirculationLaSalle427.9IndianaMedMatsuyoshi5213.5IgakuKenkyu谢维泉3088.4中国循环杂志陈宝田4006.25中华外科杂志褚衍林20610.7中国循环杂志龙国粹8010.0第一军医大学学报3.2预防气栓发生左心无层级排气装置1993年以来国内共发表以浅低温和不停跳为关键词的文章共214篇国外1MatsumotoY.Efficacyandsafetyofon-pumpbeatingheartsurgeryforvalvulardisease.AnnThoracSurg,2002,74:678-683.2GersakB.Aorticandmitralvalvesurgeryonthebeatingheartisloweringcardiopulmonarybypassandaorticclamptime.HeartSurgForum,2003,5:182-186.3GhoshS.Beating-heartmitralvalvesurgeryinpatientswithpoorleftventricularfunction.JHeartValveDis,2004,12:622-627.4TehraniH.Beatingheartaorticvalvereplacementinapregnantpatient.JCardSurg,2004,19:57-58.5Luozzo.Concomitantbeating-heartmitralvalvesurgeryandcoronaryarterybypassinpatientswithcompromisedventricularfunction.Innovations,2006,1:151-154.6CicekciogluF.Aorticvalvereplacementwithon-pumpbeatinghearttechnique.JCardSurg,2007,22:211-214.7BehrL.Beatingheartmitralvalvereplacementwithabovinepericardialbioprosthesisfortreatme