感染性心内膜炎瓣膜置换术的体外循环管理与分析

目的本文回顾性总结我院自1996年8月至2008年3月间施行的16例感染性心内膜炎（IE）行瓣膜置换术的体外循环（CPB）管理体会。方法采用中度低温（26℃-30℃），中高流量2．4～3．01／（min·m^2）]灌注。心肌保护采用4℃冷晶体停搏液或7℃～10℃ 4：1稀释血停搏液顺灌或持续逆灌。主动脉瓣膜置换术（AVR）、主动脉瓣和二尖瓣置换术（DVR）均采用冠状静脉窦逆灌。结果本组CPB总时间99～224min，主动脉阻断时间62～141min，16例均顺利脱离CPB。14例痊愈出院，术后早期死亡2例，死亡原因均为颅内出血。结论良好的设备、控制胶／晶比值、积极应用超滤器、加强ACT和凝血功能的监测，以及注重围术期抗生素的应用对患者的治疗和恢复至关重要。

Management and Analysis of Cardiopulmonary Bypass during Valve Replacement for Infective Endocarditis

OBJECTIVE To summarize retrospectively the experience of management of cardiopulmonary bypass （CPB） during valve replacement for infective endocarditis in 16 cases. METHODS Valve replacement with CPB was performed in 16 cases of infective endocarditis in our hospital between August 1996 and March 2008. CPB was performed with midlow temperature（26% -30℃ ） and moderate or high flow rate （2.4 -3.0 L/（ min·m^2）. Cardioplegia with 4℃ cold crystalloid or 7℃ - 10℃ 4： 1 （ blood： crystalloid ） was performed by antegrade or retrograde coronary sinus perfusion for myocardial protection. Only retrograde coronary sinus perfusion was performed during AVR and DVR. RESULTS The duration of CPB ranged from 99 to 224 min, and aorta cross - clamp time（ACC） from 62 to 141 min. All 16 eases were weaned from CPB successfully. 2 cases died early postoperatively due to intracranial hemorrhage, the others recovered completely. CONCLUSION The key factors for successful treatment are the use membrane oxygenator and uhrafihration, control of colloid volume, monitor of ACT and coagulation function and use of antibiotic in the patient with infective endocarditis during CPB.