负压辅助静脉引流技术在全机器人心脏手术中的应用
Application of vacuum-assisted venous drainage in total robotic cardiac surgery
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摘要: 目的 总结全机器人心脏手术中应用负压辅助静脉引流(vacuum-assist venous drainage,VAVD)技术进行体外循环(extracorporeal circulation,ECC)转流的经验。 方法 2007年1月-2011年8月使用达芬奇(da vinci S)机器人完成心脏手术体外循环转流249例。在食道超声引导下,经右侧股动、静脉及右颈内静脉插管建立ECC。ECC转流中使用VAVD辅助静脉引流,负压控制在-30——60mmHg(1mmHg=0.133kPa)。 结果 249例ECC时间40-219(105.9±38.8)min,升主动脉阻断时间21-166(69.5±30.0)min,ECC转流中尿量100-2 100(771.7±477.6)ml,超滤液量800-4 800(2 485.4±811.6)ml。16例ECC液体量为零平衡,189例ECC液体量为负平衡150-2 600(816.6±535.9)ml。 结论 机器人心脏手术需采用外周ECC,VAVD技术保证了充分的静脉引流量,能达到液体量零平衡或负平衡,是安全有效的技术。Abstract: Objective To summarize the experiences in extracorporeal circulation(ECC) with vacuum-assisted venous drainage(VAVD) in total robotic cardiac surgery. Methods ECC was established in 249 patients underwent cardiac surgery with Da Vinci S robotic surgical system in our hospital from January 2007 to August 2011 through the right femoral arterial and venous cannula,and the right internal jugular venous cannula under esophageal ultrasound guidance.VAVD was used during ECC with its pressure controlled at-30--60mmHg. Results The ECC time and aortic cross-clamp time were 40-219(105.9±38.8)min and 21-166(69.5±30.0)min,respectively.During ECC,the urine volume was 100-2 100(771.7±477.6)ml and the ultra-filtration volume was 800-4 800(2 485.4±811.6)ml in 249 patients,the total fluid balance was zero in 16 patients and negative in 189 patients150-2 600(816.6±535.9)ml. Conclusion Peripheral ECC is needed during robotic cardiac surgery.VAVD can ensure sufficient vena cava drainage with its fluid volume reached to zero or negative balance,and is thus a safe and effective technique in robotic cardiac surgery.