医学精品课件：体外循环.PPT

1、Cardiopulmonary Bypass,Jiang Yingjiu Professor Master Tutor Cardiothoracic Department The First Affiliated Hopital of Chongqing Medical University,胸心外科 欢迎你!,主任医师 胸心外科,89818339,主任医师 胸心外科,Congenital heart disease,Tetralogy of Fallot 6 years old,15 kg weight. cyanosis,clubbing fingers. wouldnt grown-up

2、 unless recieved cardiac surgery,To repair the cardiac defects Bloodless field Motionless field Stop the motion of the heart and lungs,Bloodless? Motionless? Life maintenance?,Cardiopulmonary Bypass,1 Definition 2 Basical equipments 3 Essential steps 4 Clinical application 5 Pathophysiology 6 Postop

3、erative treatment,Drains venous blood from the right atrium or vena cava by the cannula inserted into the venous system.Finishs gas exchange process including oxygen and carbon dioxide by the artifial lung(oxygenator) to change the oxygen poor venous blood into the oxygen rich arterial blood.Pumps o

4、xygenated blood back to the body by the artificial heart(pump) via arterial cannula to remain the living of the all the other organs of the body except the lung and the heart. Provides a limited 2-3 hours time during which the lung and the heart are not working for cardiac surgeon to open the heart

5、and finish a operation precisely with bloodless and motionless field.,Cardiopulmonary Bypass,By this way,the function of the lung and heart had been taken over by the extracorporeal circulation equipments. Provide the desired bloodless, motionless operative field and still supply all the other organ

6、s of the body with oxygen and nutrient-rich blood.,Heat exchanger,Summary for CPB Purpose: 1) To provide a bloodless, motionless field for heart surgery 2) Rest of body perfused while heart and lung stopped Methods: 1) Drain out venous blood 2) Oxygenated by artificial lung 3) Oxygen-rich blood pump

7、ed back by artificial heart,History Landmark in cardiac surgery! Western countries in 1953 China in 1958 The hospital here 1963 1979,John H. Gibbon,吴英恺,1 Definition 2 Basical equipments 3 Essential steps 4 Clinical application 5 Pathophysiology 6 Postoperative treatment,Basic equipments 1 artificial

8、 heart (blood pump) 2 artificial lung (oxygenator) 3 temperature exchanger 4 filter 5 tubes or cannulas,Artificial hypothemia,Using bionics principle of hibernation，lowering the body temperature can strengthen the tolerance ablility for hypoxia. Decreasing 1 of the body temperature can reduce oxygen

9、 consumption by 5%-6%. Decrease the body temperature to 28 -20 , the metabolization will be reduced to 50%-80%. Therefore, low temperature can enhance the body tolerance to hypoxia. Combine the cardiopulmonary bypass and hypothermic anesthesia together widely used in the treatment of heart disease f

10、or open intracardio surgery.,blood pump,oxygenator,temperature exchanger,tubes,1 Definition 2 Basical equipments 3 Essential steps 4 Clinical application 5 Pathophysiology 6 Postoperative treatment,Typical process for open heart surgery 1 Anesthesia 2 Supine position 3 Median sternotomy,4 Incision o

11、f the skin and subcutaneous,5 Sternum divided by saw,5 Thymus isolated 6 Incision of pericardium,7 Heart and great vessels exposed 8 Heparinize 9 Exterior exploration Chest opened by sternotomy,10 Cannulations for Aorta,SVC,IVC 11 Connect cannulations to cardiopulmonary bypass machine the bypass sys

12、tem established 12 Start the bypass machine and hypothermia 13 Aortic cross-clamp placed cardioplegia injected the heart arrested,14 Open the heart exploration and operation,Cardiopulmonary Bypass Technique,Cardiopulmonary Bypass Technique,Arterial & Venous Cannulation,Myocardial Protection,Strategi

13、es: 1 Hypothermia cold perfusate surface cooling 2 Cardioplegia K+ diastolic arrest Intermittent perfusion,Myocardial Protection,Cardioplegia: Route of administration,Antegrade,Retrograde,CPB under going,Nonpulsatile / pulsatile flow C.O. - 2-2.5 L/min/m2,15 Re-warming de-air release aortic clamp he

14、art resuscitation heart beating again 16 Heart incision suture 17 Off pump gradually remove the pipelines 18 Administration of protamine neutralize against heparin restore clotting function 19 Sternal fixation with wire 20 Close the skin incision,Anesthesia,Median sternotomy,Incision of pericardium,

15、Exterior exploration,Heparinize,Cannulations for Aorta,SVC,IVC,Start the bypass machine and hypothermia,Aortic cross-clamp placed Cardioplegia injected,Intracardiac exploration and open-heart operation,Re-warming,de-air,release aortic clamp,heart resuscitation,Off pump gradually,Neutralize against h

16、eparin restore clotting function,Sternal fixation with wire Close the skin incision,1 Definition 2 Basical equipments 3 Essential steps 4 Clinical application 5 Pathophysiology 6 Postoperative treatment,Clinical application: All the operations need open the heart Congenital heart disease Cardiac val

17、ve disease Coronary artery disease Great vessel disease Extended radical operation for various chest tumor,Congenital heart disease,Cardiac valve disease,Coronary artery disease,Great vessel disease,1 Definition 2 Basical equipments 3 Essential steps 4 Clinical application 5 Pathophysiology 6 Postop

18、erative treatment,Pathophysiology after bypass 1 Metabolic changes: acidosis and alkalosis 2 Electrolytes turbulence: hypokalemia 3 Blood damage: blood cell damage,coagulation disorder 4 Renal or lung function decrease or damage,1 Definition 2 Basical equipments 3 Essential steps 4 Clinical applicat

19、ion 5 Pathophysiology 6 Postoperative treatment,1 Haemodynamic stability 2 Correcting acid-base imbalance and electrolyte disturbance 3 Protection of renal function 4 Assisted mechanical ventilation,1 Definition 2 Basical equipments 3 Essential steps 4 Clinical application 5 Pathophysiology 6 Postoperative treatment,Thanks,