医学精品课件：12.1体外循环.PPT

1、 Jiang Yingjiu Professor Master TutorCardiothoracic Department The First Affiliated Hopital of Chongqing Medical University Congenital heart disease,Tetralogy of Fallot6 years old,15 kg weight.cyanosis,clubbing fingers.wouldnt grown-up unless recieved cardiac surgeryTo repair the cardiac defects Blo

2、odless field Motionless fieldStop the motion of the heart and lungs Bloodless?Motionless?Life maintenance?1 Definition2 Basical equipments3 Essential steps4 Clinical application 5 Pathophysiology 6 Postoperative treatment Drains venous blood from the right atrium or vena cava by the cannula inserted

3、 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 oxygenated blood back to the body by the artificial heart(pump)via arterial cannula to remain the

4、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 and finish a operation precisely with bloodless and motionless field.Cardiopulmonary BypassBy this

5、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 organs of the body withoxygen and nutrient-rich blood.Heat exchangerSummary for CPB1 Purpose:1)To provide a

6、bloodless,motionless field for heart surgery 2)Rest of body perfused while heart and lung stopped2 Methods:1)Drain out venous blood 2)Oxygenated by artificial lung 3)Oxygen-rich blood pumped back by artificial heart History Landmark in cardiac surgery!Western countries in 1953 China in 1958 The hosp

7、ital here 1963 1979 John H.Gibbon吴英恺吴英恺1 Definition2 Basical equipments3 Essential steps4 Clinical application 5 Pathophysiology 6 Postoperative treatment Basic equipments 1 artificial heart(blood pump)2 artificial lung(oxygenator)3 temperature exchanger4 filter5 tubes or cannulasArtificial hypothem

8、iaUsing bionics principle of hibernation，lowering the body temperature can strengthen the tolerance ablility for hypoxia.Decreasing 1 of the body temperature can reduce oxygen consumption by 5%-6%.Decrease the body temperature to 28 -20,the metabolization will be reduced to 50%-80%.Therefore,low tem

9、perature can enhance the body tolerance to hypoxia.Combine the cardiopulmonary bypass and hypothermic anesthesia together widely used in the treatment of heart disease for open intracardio surgery.blood pumpoxygenator temperature exchangertubes 1 Definition2 Basical equipments3 Essential steps4 Clin

10、ical application 5 Pathophysiology 6 Postoperative treatment Typical process for open heart surgery 1 Anesthesia 2 Supine position 3 Median sternotomy4 Incision of the skin and subcutaneous5 Sternum divided by saw 5 Thymus isolated 6 Incision of pericardium 7 Heart and great vessels exposed 8 Hepari

11、nize 9 Exterior exploration Chest opened by sternotomy10 Cannulations for Aorta,SVC,IVC11 Connect cannulations to cardiopulmonary bypass machine the bypass system established12 Start the bypass machine and hypothermia13 Aortic cross-clamp placed cardioplegia injected the heart arrested14 Open the he

12、art.exploration and operationCardiopulmonary Bypass TechniqueArterial&Venous CannulationMyocardial ProtectionStrategies:1 Hypothermiacold perfusatesurface cooling2 Cardioplegia K+diastolic arrest Intermittent perfusion Cardioplegia:lRoute of administrationAntegradeRetrogradeCPB under going Nonpulsat

13、ile/pulsatile flowC.O.-2-2.5 L/min/m2 15 Re-warming de-air release aortic clamp heart resuscitation heart beating again16 Heart incision suture17 Off pump gradually remove the pipelines18 Administration of protamine neutralize against heparin restore clotting function19 Sternal fixation with wire20

14、Close the skin incision Anesthesia Median sternotomyIncision of pericardium Exterior exploration HeparinizeCannulations for Aorta,SVC,IVCStart the bypass machine and hypothermiaAortic cross-clamp placed Cardioplegia injectedIntracardiac exploration and open-heart operation Re-warming,de-air,release

15、aortic clamp,heart resuscitationOff pump graduallyNeutralize against heparin restore clotting functionSternal fixation with wireClose the skin incision 1 Definition2 Basical equipments3 Essential steps4 Clinical application 5 Pathophysiology 6 Postoperative treatment Clinical application:All the ope

16、rations need open the heartCongenital heart disease Cardiac valve disease Coronary artery disease Great vessel diseaseExtended radical operation for various chest tumorCongenital heart disease Cardiac valve disease Coronary artery diseaseGreat vessel disease1 Definition2 Basical equipments3 Essentia

17、l steps4 Clinical application 5 Pathophysiology 6 Postoperative treatment Pathophysiology after bypass1 Metabolic changes:acidosis and alkalosis2 Electrolytes turbulence:hypokalemia3 Blood damage:blood cell damage,coagulation disorder4 Renal or lung function decrease or damage1 Definition2 Basical e

18、quipments3 Essential steps4 Clinical application 5 Pathophysiology 6 Postoperative treatment 1 Haemodynamic stability 2 Correcting acid-base imbalance and electrolyte disturbance 3 Protection of renal function4 Assisted mechanical ventilation 1 Definition2 Basical equipments3 Essential steps4 Clinical application 5 Pathophysiology 6 Postoperative treatment Thanks