老年患者心脏手术体外循环的临床实践

摘要

目的 回顾总结和分析老年患者心脏手术体外循环(ECC)的灌注管理经验临床效果.方法 从2008年10月至2010年12月,选择60例施行冠状动脉旁路移植术(CABG,n=32),二尖瓣置换(MVR,n=8),主动脉瓣置换(AVR)+CABG(n=3),MVR+CABG(n=3),二尖瓣成形(MVP,n=12),MVP+CABG(n=2)的患者按其年龄分为老年组(50～73岁,n=36)和成年组(33～49 岁,n=24).两组患者的一般情况、手术方式、体外循环方法等基本相同.对老年患者采用了持续冷血逆行灌注心肌保护、高流量灌注、胰岛素输注方案控制血糖、超滤、低温混合肺保护液行肺灌注等.结果 两组患者体重、性别以及术前一般情况等差异无统计学意义.60例患者心脏自动复跳51例,占85%;电击复律9例,占15%.老年组与成年组相比,术后住院时间缩短[(12.76±3.04)d vs (16.48±5.43)d,P<0.05];术后房颤发生率降低(36.7% vs 53.3%,P<0.05);术后感染发生率降低(6.7% vs 20%,P<0.05),围手术期死亡1例,其余患者均痊愈出院.结论 在术中对老年患者采取胰岛素输注方案控制血糖和乌司他丁与氧合机器血混合配成低温肺保护液进行肺保护等特殊方法,有利于术后恢复.%OBJECTIVE To review the clinical application of extracorporeal circulation ( ECC ) on aged patients ( ≥ 50 years ) who were performed heart operations. METHODS From October 2008 to December 2010, a total of 60 selective patients were divided into two groups according to their age: the aged group ( ≥50 years, n =36 ) and the adult group ( ≤49 years, n =24 ).The operation procedure included coronary artery bypass graft ( CABG, n= 32 ), mitral valve replacement ( MVR, n= 8 ), aortic valve replacement ( AVR ) + CABG ( n =3 ), MVR + CABG ( n =3 ), mitral valvuloplasty ( MVP, n= 12 ) and MVP + CABG ( n =2 ). The general state, modus operandi and the method of ECC were the same of the two groups. For the aged group, continous cold blood protection of retrograde coronary sinus perfusion ( RCSP ), high perfusion flow, insulin infusion on perioperative blood glucose control, ultrafiltration technique and oxygen blood be mixed hypothermia lung protection liquid were used during ECC. RESULTS There were no significant differences in patients'weight, sexuality and general conditions between the two groups ( P ＞ 0.05 ). Automatic heart beat recovery rate was 85％ ( 51/60 patients ) and electrical cardioversion rate was 15％ ( 9 cases ). Compared with that in the aged group, the time of hospitalization after operation was decreased ( ( 12.76 ± 3.04 ) d vs ( 16.48 ± 5.43 ) d, P ＜ 0.05 ), the incidence of postoperative atrial fibrillation was decreased ( 36.7％ vs 53.3％ , P ＜ 0.05 ) and the incidence of postoperative infection was also decreased ( 6.7％ vs 20％ , P ＜0.05 ) in the adult group. Except one patient occurred sternum infection postoperatively and one died of cardiac failure after operation, the others recovered. CONCLUSION To aged patients ( ≥ 50 ) during heart operations, the way of insulin infusion on perioperative blood glucose control and ulinastatin and oxygen blood be mixed hypothermia lung protection liquidcan protect lung. With effective ECC management, heart operation in senior is safe.