摘要目的 探讨机器人辅助心脏手术体外循环(ECC)建立方法与灌注管理策略.方法 2007年1月至2011年3月,使用达芬奇S(da Vinci S)机器人系统在ECC支持下完成心脏手术226例,其中房间隔缺损修补111例(包括部分肺静脉异位引流矫治3例),室间隔缺损9例,二尖瓣成形51例,二尖瓣置换20例,左心房黏液瘤摘除27例,有心房黏液瘤摘除4例.1例二尖瓣成形手术采用股动脉、双腔股静脉插管,225例经股动脉、股静脉及颈内静脉插管建立ECC.ECC采用浅低温、中流量灌注,灌注中负压辅助静脉引流(VAVD),控制负压-60～-30 mm Hg(1 mm Hg=0.133 kPa),连续动脉血气监测(CDI-500)并适时超滤.45例手术采用心脏不停跳方法,10例于术使用康斯特保护液(HTK液)进行心肌保护.其余手术均采用4∶1含血冷停搏液(St.Thomas液)经升主动脉顺行、间断灌注.结果 226例患者ECC转流40～219(105.9±38.8)min,升主动脉阻断21～166(69.5±30.0)min,ECC转流中尿量100～2100(771.7±477.6)ml,超滤液量1000～4800(2495.4 ±811.6)ml.ECC液体量,13例为零平衡,172例为负平衡[150～2600(816.6±535.9)ml].1例术后凶感染致多器官功能衰竭死亡,余均无并发症,出院.结论 机器人辅助心脏手术需经外周建立ECC.灌注中使用VAVD、连续血气监测和加强ECC灌注管理十分必要.

abstractsObjective To discuss the way and management of extracorporeal circulation (ECC) for totally robotic assisted cardiac surgery. Methods A Total of 226 patients underwent cardiac surgery using da Vinci S robotic surgical system, including 111 patients underwent atrial septal defect repair ( ASDR) , 9 patients underwent ventricular septal defect repair ( VSDR) ,51 patients underwent mitral valvuloplasty ( MVP) , 20 patients underwent mitral valve replacement( MVR) , 27 patients underwent left atrial myxoma excise and 4 patient underwent right atrial myxoma excise. ECC for most of patients was achieved with femoral arterial cannula, femoral venous cannula and right internal jugular venous cannula, except for 1 patient underwent MVP with femoral arterial cannula and femoral two-stage venous cannula. In all the cases, vacuum-assist venous drainage ( VAVD) , continuous blood gas monitoring and ultrafiltration were used during ECC. myocardial protection was pertic cross-clamp time was 40 ～219 (105.9+38. 8)min and 21 ～166 (69.5±30.0)min respectively. During ECC, the mean urine volume was 100-2100 (771.7±477.6) ml, ultrafiltration volume was 1000-4800 (2495.4 ±811.6) ml, and the total fluid balance was subzero-balanced (172 cases) or zero-balanced(13 cases) in most of patients. Conclusion The establishment of ECC system through peripheral vessels, using VAVD and continuous blood gas monitoring are the key points of ECC for totally robotic assisted cardiac surgery, also certain learning curve of perfusion technique and close communication between the surgical team are essential during ECC.