CAJ | 학술논문

目的：探讨急诊心脏手术中止血困难的主要原因以及针对性处理对策。方法选择我院2010年9月—2014年9月术中止血时间≥2 h或止血过程中出血量>300 ml等术中止血困难的急诊心脏手术患者41例,探讨术中止血困难可能的原因及相应处理措施的效果。结果本组21例DeBakey Ⅰ型主动脉夹层行Sun's术术中止血困难,其中7例为吻合口出血(5例予加固缝合、输血液制品等综合措施后出血控制,2例采取各种措施仍无法止血者以纱布填塞延期处理),14例术野广泛渗血采取综合措施后出血控制。17例行急诊冠脉搭桥者术中术野广泛渗血,采取综合措施后出血控制。3例心脏移植者因吻合口出血、术野广泛渗血致术中止血困难,经加固缝合等综合措施后出血控制。术后无因出血而再次手术者,2例死亡(1例行SUN's手术者发生多器官功能衰竭,1例行急诊冠脉搭桥者发生低心排出量综合征)。结论术前一般情况差、术前抗凝、体外循环、疾病因素为急诊心脏手术术中止血困难的主要原因,采取缝合、纠正凝血状态并其他措施为补充的综合措施可收到较好的效果。
목적：탐토급진심장수술중지혈곤난적주요원인이급침대성처리대책。방법선택아원2010년9월—2014년9월술중지혈시간≥2 h혹지혈과정중출혈량>300 ml등술중지혈곤난적급진심장수술환자41례,탐토술중지혈곤난가능적원인급상응처리조시적효과。결과본조21례DeBakey Ⅰ형주동맥협층행Sun's술술중지혈곤난,기중7례위문합구출혈(5례여가고봉합、수혈액제품등종합조시후출혈공제,2례채취각충조시잉무법지혈자이사포전새연기처리),14례술야엄범삼혈채취종합조시후출혈공제。17례행급진관맥탑교자술중술야엄범삼혈,채취종합조시후출혈공제。3례심장이식자인문합구출혈、술야엄범삼혈치술중지혈곤난,경가고봉합등종합조시후출혈공제。술후무인출혈이재차수술자,2례사망(1례행SUN's수술자발생다기관공능쇠갈,1례행급진관맥탑교자발생저심배출량종합정)。결론술전일반정황차、술전항응、체외순배、질병인소위급진심장수술술중지혈곤난적주요원인,채취봉합、규정응혈상태병기타조시위보충적종합조시가수도교호적효과。
Objective To examine the risk factors for difficult hemostasis in emergency cardiac surgery and evaluate the treatment strategy. Methods 41 cases were selected from 85 patients undergoing emergency cardiac operation during September 2010 and September 2014 in our hospital. It was considered as difficult hemostasis that if total time for hemostasis was over 2 h or 300 ml of blood loss during this period. Data was collected from the selected patients, risk factors related to difficult hemosta-sis in emergency cardiac surgery were indentified and effects of different measures for hemostases were evaluated. Results 21 cases undergoing Sun's operation for Aortic Dissection ( Debakery typeⅠ) , had difficult hemostasis, 7 cases were stoma hemosta-sis, among which, 5 cases with suture and blood transfusion comprehensive measures, the hemostasis was controlled;2 cases as-lo had difficult hemostasis with all measures tried, but fail to control the hemostasis, therefore gauze packing was used to deter hemostasis;14 cases of Debakery typeⅠand 17 cases of emergency coronary artery bypass and 3 cases of heart transplantation ex-perienced difficult hemostasis (major causes were leakage of anastomosis and angiostaxis of wound surface). All treatments of various measures for hemostasis ( eg. enhanced suture and multi-coagulant substance) were effective and only 2 patients died af-ter operation (1 patient undergoing Sun's operation died of multiple organ failure, another undergoing emergency coronary artery bypass died of low cardiac output syndrome). Conclusion Extracorporeal circulation, pathology and physiology of diseases, poor physical condition and preoperative anticoagulant usage are specific high risk factors of difficult hemostasis in emergency cardiac surgery, and multiple-treatments based on analysis of possible causes are effective to control difficult hemostasis.