中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

改良股动、静脉插管体外循环中器官灌注效果的实验研究

查看全文

目的 比较改良股动、静脉插管体外循环(CPB)与常规CPB在相同流量灌注时对脑、肺、肝、肾、肠等重要器官灌注的效果。 方法 将20条犬(体重10~15 kg)随机分为两组,每组10条。胸腔镜组:改良股动、静脉插管后建立CPB,经电视胸腔镜施行手术;常规开胸组:常规建立CPB手术。两组建立CPB后以相同的流量灌注,分别在无名动脉、左颈总动脉、肠系膜上动脉、肾动脉、对侧动脉、同侧动脉及其所有相伴行的静脉留置套管针,连接测压管道,于麻醉诱导后即刻(T1) 、主动脉阻断前(T2) 、主动脉阻断15min (T3) 、主动脉开放15min (T4) 、CPB结束后20min (T5)记录动、静脉压,并在以上时间点抽取相应部位静脉血测定静脉血氧饱和度(SvO2) . 结果 除了胸腔镜组同侧动脉灌注压明显低于常规开胸组(Plt;0. 01)外,两组其余动脉的动脉灌注压比较差异均无统计学意义。主动脉阻断前、主动脉阻断15min、主动脉开放15min,胸腔镜组肾静脉、肠系膜上静脉、对侧静脉和同侧静脉的静脉压明显高于常规开胸组(Plt;005) ;胸腔镜组肾静脉、肠系膜上静脉、对侧静脉和同侧静脉SvO2低于常规开胸组(Plt;005) . 结论 改良股动、静脉插管与常规CPB相同流量灌注时其动脉灌注压相近,经股动、静脉插管下腔静脉平面以下的静脉压较常规开胸手术略高,因此,对小儿胸腔镜CPB的器官保护提供了理论依据

Objective To compare the perfusion pressure between cardiopulmonary bypass (CPB) through improved intubations of femoral artery-vein and routine identical flow on organic perfusion such as brain, lung, liver, kidney, intestines, etc.. Methods Twenty dogs with body weight from 10-15kg were randomly divided into two groups: thoracoscope group(n=10): CPB was set up by the right femoral artery-vein for completely video assisted cardiac operations; routine thoracotomy group(n=10): CPB was set up by the aorta-caval vein. The perfusion pressure of innominate artery, left common carotid artery, superior mesenteric artery, renal artery, homonymic and opposite side popliteal artery and the pressure of concomitant vein were measured at the following time points: instantly after induction of anesthesia (T1) , before aortic clamping (T2) , fifteen minutes after aortic clamping (T3) , fifteen minutes after aortic opening (T4) , twenty minutes after stop (T5) . The venous blood samples were collected at the preceding time points and venous oxygen saturation (SvO2) were measured. Results There were no significant difference between both groups in arterial perfusion pressure, besides perfusion pressure of homonymic popliteal artery in thoracoscope group was lower than that in routine thoracotomy group (Plt;0. 01) . Before aortic clamping, fifteen minutes after aortic clamping and fifteen minutes after aortic opening, venous pressure of renal vein, superior mesenteric vein, homonymic and opposite side popliteal vein in thoracoscope group were higher than those in routine thoracotomy group (Plt;0. 05) . SvO2 of renal vein, superior mesenteric vein, homonymic and opposite side popliteal vein in thoracoscope group were lower than those in routine thoracotomy group (Plt;0. 05) . Conclusion The improved femoral CPB has a similar perfusion pressure with routine CPB and a higher vein pressure than routine CPB below inferior vena cava after aortic intubations. So this experiment provides theoretical evidence for the organic protection of infants’ thoracoscopic extracorporeal circulation.

关键词: 股动、静脉; 体外循环; 灌注压; 静脉压

Key words: Femoral artery-vein; Cardiopulmonary bypass; Perfusion pressure; Venous pressure

引用本文: 陈涛,魏旭峰,易定华等. 改良股动、静脉插管体外循环中器官灌注效果的实验研究. 中国胸心血管外科临床杂志, 2007, 14(6): 433-. doi: 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
1.  易定华. 胸腔镜心脏外科进展. 中国心血管病研究杂志,2005, 5 (5) : 325-326.
2.  俞世强,程云阁,蔡振杰,等. 胸腔镜心脏手术并发症分析. 第四军医大学学报,2003, 24 ( 3) : 263-264.
3.  段大为,程云阁,张铁柱,等. 胸腔镜心脏手术微创体外循环的建立方法. 心肺血管病杂志,2001, 20 (1) : 32-33.
4.  段大为,刘维永,朱海龙,等. 电视胸腔镜在小儿心脏手术中的应用. 中国内镜杂志,2003, 9 (8) : 7-11.
5.  段大为,王晓武. 胸腔镜心脏手术体外循环的建立及心肌保护方法. 生物医学工程与临床,2003, 7(2): 128-129.
6.  段大为,陈德凤,杜鹃,等. 股动、静脉插管体外循环在电视胸腔镜心脏手术中的应用. 中国胸心血管外科临床杂志,2005, 12(4): 247-249.
7.  Chang CH, Lin PJ, Chu JJ, et al. Video-assisted cardiac surgery in closure of atrial septal defect. Ann Thorac Surg, 1996, 62(3): 697-701.
8.  Lin PJ, Chang CH, Chu JJ, et al. Minimally invasive cardiac surgical techniques in the closure of ventricular septal defect: an alternative approach. Ann Thorac Surg, 1998, 65(1): 165-169.
9.  俞世强,蔡振杰,程云阁,等. 胸腔镜下室间隔缺损修补术. 中国微创外科杂志,2002, 5 (5) : 263-264.
10.  Stockard JJ, Bickford RG, Schauble JF. Pressure-dependent cerebral ischemia during cardiopulmonary bypass. Neurology, 1973, 23(5): 521-529.