主动脉瓣和二尖瓣联合置换术的体外循环管理体会.doc

主动脉瓣和二尖瓣联合置换术的体外循环管理体会 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：主动脉瓣和二尖瓣联合置换术的体外循环管理体会 1 1 资料与方法 2 2 结 果 4 3 讨 论 4 文2：主动脉弓中断矫治术中体外循环管理体会 6 1 材料和方法 7 2　结果 8 3　讨论 9 参考文摘引言： 10 原创性声明（模板） 12 文章致谢（模板） 12 正文 主动脉瓣和二尖瓣联合置换术的体外循环管理体会 文1：主动脉瓣和二尖瓣联合置换术的体外循环管理体会 Abstract: OBJECTIVE To summarize the clinical experience of cardiopulmonary bypass(CPB) in double valve replacement. METHODS 31 patients (Male 15,Female 14) aged from 30 to 62 yea old underwent, double valve replacement under hypothermic membrane oxygenator was selected. The human albumin,fresh-frozen plasma and artificial colloids were primed and added during CPB if protection was performed with blood crystalloids(4∶1)hyperkalemia cardioplegia. High perfusion flow 50-100 ml/kg and high mean arteria pressure 50-90 mmHg was performed during CPB. Ultrafiltration technique,suspened red blood cell, and furosemide were used for the raise of Hct during late CPB. RESULTS CPB time and aortic cross-clamp time was 137-254 min and 91-168 min incidence of automatic heart resuscitation was %(23/31). None of the patients died during surgery. All patients weaned successfully from Management of CPB on patients with double valve replacement operatio should focus on the raise of blood colloids pressure, the myocardial protection and the monitoring and control of Hct during CPB. The compreheive measures maybe the key for the success of CPB. Key words： Cardiopulmonary bypass; Double valve replacement; Experience 瓣膜病患者由于长期容量负荷及压力负荷加重，心脏扩大，心肌受损，心功能差。特别是联合瓣膜病患者病情更重，手术时间长，手术死亡率较高。因此，其对体外循环(cardiopulmonary bypass,CPB)管理的要求更高。本文分析总结我院2003年10月至2007年12月所施行的31例主动脉瓣和二尖瓣联合瓣膜置换术(double valve replacement,DVR)的CPB管理体会，报告如下： 1 资料与方法 一般资料 31例心脏联合瓣膜病患者中，男15例，女16例，年龄30～62岁，体重43～71kg。X线胸片心胸比(C/T)～，均有不同程度的肺瘀血，心功能Ⅲ级10例，IV级11例，左室舒张末期直径(LVEDD)70mm者22例;70～80 mm者7例;80 mm者2例,平均(67±)mm，左室射血分数(LVEF)≥50% 21例;30%～49% 7例;30% 3例，合并心房纤颤8例，心室肥厚16例，肺动脉平均压40 mmHg者11例， 70 mmHg 2例;左房有附壁血栓者3例。均行DVR，其中15例加三尖瓣环缩,2例加左房折叠术，3例加左房附壁血栓清除术。 CPB方法 CP