摘要目的:对比分析新型闭合式股静脉-股动脉体外循环(closed-CPB)与开放式体外循环(open-CPB)在全胸腹主动脉置换术中的应用效果。方法:2018年11月至2023年5月阜外华中心血管病医院在股静脉-股动脉体外循环辅助下共完成46例全胸腹主动脉置换术。为了更好应对"分段阻断"带来的血流动力学紊乱，我们改进回路连接方式：在开放式回路的基础上，将静脉引流管用3/8英寸"Y"型接头分出管路直接连于离心泵入血口；储血器出血口连接滚压泵，滚压泵后管路用3/8英寸"Y"型接头连接于离心泵出血口和膜肺入血口之间；钳闭储血器入血口，可以隔离储血器实现闭合式转流。在closed-CPB辅助下共完成15例全胸腹主动脉置换术(closed-CPB组)，我们将其与先前应用open-CPB完成的病例(open-CPB组)进行对比分析，收集两组患者围术期临床资料，首要观察指标为术中和术后24 h血压、血制品用量、血液回收量、乳酸水平和缩血管药物用量，次要观察指标为并发症和临床结局等。计量资料、计数资料比较分别采用 t检验、 U检验、 χ2检验或Fisher确切概率法。 结果:closed-CPB组的血制品用量少于open-CPB组，其中在术中和术后24 h红细胞用量、冷沉淀用量方面差异有统计学意义[2.0(0.0，4.0)比4.5(2.3，8)， Z＝2.563， P<0.05；3.0(0.0，3.8)比4.0(3.8，8.0)， Z＝2.950， P<0.01；0(0，0)比6(0，10.0)， Z＝2.973， P<0.01]。closed-CPB组的血液回收量明显少于open-CPB组[800(670，855)比1 500(811，1 950)， Z＝2.977， P<0.01]。open-CPB组的缩血管药物用量明显多于closed-CPB组，其中多巴胺泵入药量和去氧肾上腺素单次给药量分别为[(19.4±5.6)比(37.5±9.9)， t＝－6.576， P<0.01]和[(0.6±0.1)比(1.4±0.3)， t＝－8.836， P<0.01]，然而，其SBP(Systolic Blood Pressure)低于80 mmHg的时间却明显长于closed-CPB组[(47.6±9.5)比(32.7±8.9)， t＝－5.105， P<0.01]，open-CPB组的最高Lac水平亦显著高于closed-CPB组[(10.2±3.6)比(4.6±2.4)， t＝－5.488， P<0.01]。open-CPB组30 d内死亡率明显高于closed-CPB组[7(22.6%)比0(0)， χ2＝2.437， P<0.01]。 结论:新型回路连接方式可以安全地实现闭合式体外转流，通过调节滚压泵能够更为方便和有效地调控有效循环血量，及时回输失血，维持血流动力学稳定和良好的组织灌注。

abstractsObjective:To compare the effects of the novel closed femoral vein-femoral artery cardiopulmonary bypass (closed-CPB) with open-CPB in thoracoabdominal aortic replacement (TAAAR).Methods:From November 2018 to May 2023, Fuwai Central China Cardiovascular Hospital completed 46 cases thoracoabdominal aortic replacement assisted by femoral vein-femoral artery cardiopulmonary bypass. In order to better cope with the hemodynamic disorder caused by "clamp and sew", we improved the circuit connection: on the basis of the open circuit, the venous drainage tube was directly connected to the centrifugal pump inlet with a 3/8-inch "Y" connector. The blood reservoir outlet was connected to the roller pump, and the pipeline after the roller pump was connected to the outlet of the centrifugal pump and the front of the oxygenator with a 3/8-inch "Y" connector. When the blood reservoir was clamped, we could isolate the blood reservoir to achieve closed-CPB. A total of 15 cases of TAAAR were completed under the closed-CPB (closed-CPB group), and we compared them with previous cases under open-CPB (open-CPB group). To collect perioperative clinical data of two groups, and the primary endpoints were intraoperative and 24 h postoperative blood pressure, blood product dosage, blood salvage amount, lactate level and vasoconstriction drug dosage. The secondary endpoints were complications and clinical outcomes. The comparison of measurement data was carried out by t-test, U-test, χ2 test or Fisher exact probability method, respectively. Results:The amount of blood products used in the closed-CPB group was less than in the open-CPB group, and there were significant differences in red blood cell dosage and cryoprecipitate dosage intraoperative and 24h after surgery, [2.0 (0.0, 4.0) vs. 4.5 (2.3, 8), Z=2.563, P<0.05; 3.0 (0.0, 3.8) vs. 4.0 (3.8, 8.0), Z=2.950, P<0.01; 0 (0, 0) vs. 6 (0, 10.0), Z=2.973, P<0.01]. The amount of cell saver was significantly lower in the closed-CPB group [800 (670, 855) vs. 1 500 (811, 1 950), Z=2.977, P<0.01]. The consumption of vasoconstriction drugs in the open-CPB group was significantly higher than in the closed-CPB group, where dopamine and phenylephrine were [(19.4±5.6) vs. (37.5±9.9), t=-6.576, P<0.01] and [(0.6±0.1) vs. (1.4±0.3), t=-8.836, P<0.01] respectively, however, the time of SB P<80 mmHg was significantly longer than in the closed-CPB group [(47.6±9.5) vs. (32.7±8.9), t=-5.105, P<0.01], and the highest Lac level was also significantly higher than in the closed-CPB group [(10.2±3.6) vs. (4.6±2.4), t=-5.488, P<0.01]. The mortality within 30 days in open-CPB group was significantly higher than that in closed-CPB group [7 (22.6%) vs. 0 (0), χ2=2.437, P<0.01]. Conclusion:The new circuit connection method can safely realize closed cardiopulmonary bypass, and adjust the roller pump to more conveniently and effectively regulate the effective circulating blood volume, timely return of shed blood, and maintain hemodynamic stability and good tissue perfusion.