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为探讨高原地区体外循环及心肺保护的特点,回顾性总结在拉萨地区施行20例心脏手术的心肺转流经验。采用浅低温、中度稀释、供纯氧、加大气/血比、增加碳酸氢钠用量等以维持接近术前的血气指标;采用不停跳、冷晶体停搏液及持续温血灌注等心肌保护方法;20例均使用膜肺、加大激素和抑肽酶用量以及17例用超滤,以保护血液及脑、肺功能。结果:20例手术经过均顺利,均痊愈出院。其中12例停机后需多巴胺维持血流动力,5例肺动脉压力较高者使用血管扩张药。结论:高原地区体外循环有以下特点应引起注意:组织氧储备少,认识充分供氧的重要性;及时纠正顽固的代谢性酸中毒;更重视对肺的保护。
To investigate the characteristics of cardiopulmonary bypass (CPB) and cardiopulmonary protection in the plateau, the experience of cardiopulmonary bypass in 20 cases of cardiac surgery in Lhasa was retrospectively reviewed. Using mild hypothermia, moderate dilution for pure oxygen, increase the air / blood ratio, increase the amount of sodium bicarbonate to maintain close to the preoperative blood gas indicators; beating, cold crystalloid cardioplegia and continuous warm blood perfusion and other myocardial Protection methods; 20 cases were used membrane lung, increase the amount of hormones and aprotinin and 17 cases with ultrafiltration to protect the blood and brain, lung function. Results: All the 20 surgeries were well discharged and were discharged. Among them, 12 patients required dopamine to maintain hemodynamics after shutdown, and 5 patients with higher pulmonary arterial pressure used vasodilators. CONCLUSION: Extracorporeal circulation in plateau area should pay attention to the following characteristics: less tissue oxygen reserve, understanding the importance of adequate oxygen supply; timely correction of stubborn metabolic acidosis; more emphasis on the protection of the lungs.