目的 探讨有效控制主动脉根部置换术中局部出血的有效方法.方法 对行主动脉根部置换术的患者,采用瘤体血管片或自体心包片缝合包裹人造血管及吻合口,并与右心房房顶、右心耳部行吻合,建立与右心房间的交通,将人造血管及各吻合口渗血引流入右心房内.结果 7例主动脉根部置换手术患者中无需要再次开胸止血,出院前心脏超声检查局部均未发现左向右分流.患者停体外循环后平均止血关胸时间大为缩短[(47.65±33.45)min],术中出血量及术后24 h引流量显著减少[(187.26±83.82)ml],术后心律失常等并发症发生率无明显变化.结论 主动脉根部置换手术中,控制人造血管各吻合口局部渗血是个难题,采用瘤囊壁或自体心包片缝合包裹人工血管形成腔隙,与右心房内引流方法是控制出血的有效方法,可避免大量失血及长时间止血带来的严重的并发症甚至死亡.%Objective To explore a modus operandi in creating a chamber around the artificial blood vessel to right atrial to control the uncontrollable bleeding during aortic root replacement operation. Methods A chamber around the aortic graft was created by suturing tumor cystis piece or a patch of autologous pericardium, and then the chamber was communicated with the right atrial to drain capillary hemorrhage from the root stoma. Results None of these patients required re - expbrasion for bleeding and they were discharged from the hospital without arrhythmia or other complications. All 7 patients underwent echocardiogaph examination before discharge and no perigraft to right atrial shunt was detected. The time of stoping bleeding and closing chest was largely shortened ( 47. 65 ± 33. 45min ) and volume of bleeding during operation and the first 24h drainage ( 187. 26 ± 83. 82ml ) was significantly decreased. Conclusion Internal drainage to right atrial is a effective mean to control bleeding and avoid the happens of severe complications and even death during the aortic root replacement operation.
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