淺低溫體外循環(huán)與心臟跳動中的瓣膜置換手術(shù)

廣西醫(yī)科大學(xué)第一附屬醫(yī)院心胸外科何巍中低溫體外循環(huán)心停跳深低溫停循環(huán)心停跳淺低溫體外循環(huán)心不停跳每降低1℃代謝率↓6～7%37℃～32±1℃代謝率↓24～35%體溫（℃）代謝率（%）36.810031.875～8030.060～7026.85020.02516.82015.015溫度與代謝率的關(guān)系溫度升高，氧離曲線右移，促使O2釋放，溫度降低，不利于O2的釋放。血液溫度降低能同時使血紅蛋白對O2的親和力上升，不利于O2的釋放32±1℃時氧離曲線右移，O2的釋放正常?？仗男呐K代謝氧耗量↓45～70%左右氧合動脈血的機(jī)體循環(huán)和冠狀循環(huán)維持了機(jī)體和心臟的代謝和氧耗。順灌法山羊左心室心肌超微結(jié)構(gòu)變化情況順灌法山羊左心室心肌超微結(jié)構(gòu)變化情況CPB120minCPB150min實(shí)驗(yàn)組對照組實(shí)驗(yàn)組對照組細(xì)胞核－－－－線粒體－+－++肌原纖維－－－－細(xì)胞膜－－－+內(nèi)皮水腫－－－+間質(zhì)水腫－+－++糖原顆粒減少－+－++－：無明顯變化；+：輕度改變；++：中度改變；+++：重度改變1.1臨床資料逆行灌注示意圖2結(jié)果

換瓣前換瓣后3討論作者例數(shù)早期死亡率(%)雜志Houser4910.2ConnMedBojar

527.7AnnThoracSurgDaenen6476.8JThoracCardiovascSurgAranki7176.6CirculationElayda17117.5CirculationLaSalle427.9IndianaMedMatsuyoshi5213.5IgakuKenkyu謝維泉3088.4中國循環(huán)雜志陳寶田4006.25中華外科雜志褚衍林20610.7中國循環(huán)雜志龍國粹8010.0第一軍醫(yī)大學(xué)學(xué)報3.2預(yù)防氣栓發(fā)生左心無層級排氣裝置1993年以來國內(nèi)共發(fā)表以淺低溫和不停跳為關(guān)鍵詞的文章共214篇國外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