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阜外心血管病医院系列丛书:阜外心血管体外循环手册

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《阜外心血管病医院系列丛书:阜外心血管体外循环手册》旨在普及体外循环从业人员的专业水平。《阜外心血管病医院系列丛书:阜外心血管体外循环手册》力求最大限度地简明扼要,每一章节的内容一目了然,故很少有理论指导。在编写过程中,力求突出以下特点:首先是实用性,通过《阜外心血管病医院系列丛书:阜外心血管体外循环手册》能够掌握体外循环基本知识和基本技术,包括围手术期的体外循环管理和并发症预防等。其次是权威性,编写人员有较丰富的临床经验,编写内容都是经过临床检验的,对有争议和不确定的内容并未写出。再次是《阜外心血管病医院系列丛书:阜外心血管体外循环手册》具有较完整的系统性。
Content Description

《阜外心血管病医院系列丛书:阜外心血管体外循环手册》一书由阜外心血管病医院体外循环科十几位作者共同撰写而成,《阜外心血管病医院系列丛书:阜外心血管体外循环手册》以精炼使用为特点,内容涉及到心血管体外循环的各个方面。包括体外循环仪器设备、体外循环前准备和评估、体外循环技术操作常规、术中监测和管理、不同病种体外循环操作、术中重要脏器的保护等内容。同时对体外循环期间的意外、非心脏手术的体外循环管理及ECMO等也有较为详尽的介绍。《阜外心血管病医院系列丛书:阜外心血管体外循环手册》内容丰富,简明扼要,紧密结合临床,非常适合于体从事外循环、心血管麻醉及心外科的医师及相关人员临床工作时随手翻阅和参考。
Catalogue

第一篇 体外循环仪器设备
第一章 体外循环机
第二章 变温系统
第一节 低温在CPB中的应用
第二节 变温水箱
第三章 氧合器
第一节 气体的交换与运输
第二节 氧合器的工作原理
第三节 氧合器中血液的破坏
第四节 氧合器性能的综合评价
第五节 ECM0氧合器
第四章 插管与管道
第一节 体外循环管道
第二节 体外循环插管
第三节 滤器
第二篇 体外循环技术操作常规
第五章 血液超滤技术
第六章 体外循环前的准备
第一节 体外循环手术前期的物品准备
第二节 CPB前的准备工作
第七章 血液稀释与预充
第一节 血液稀释
第二节 CPB预充和血液稀释方法
第三节 CPB中的预充液
第八章 围体外循环期监测
第一节 物理观察
第二节 血流动力学监测
第三节 心电图(ECG)监测
第四节 经食管超声心动图(TEE)
第五节 体外循环系统监测
第六节 出凝血监测
第七节 中枢神经监测
第八节 组织灌注/氧合监测
第九章 血流动力学监测和管理
第一节 全身血流动力学监测
第二节 重要脏器血流动力学的管理
第三节 血管活性药物在体外循环中的应用
第十章 体外循环前并行和后并行的管理
第一节 前并行的管理
第二节 后并行的管理
第三节 停止体外循环
第十一章 体外循环中水电解质代谢管理
第一节 体外循环中水代谢紊乱和纠正
第二节 体外循环中钾代谢紊乱和纠正
第三节 体外循环中钙代谢紊乱和纠正
第四节 体外循环中镁代谢紊乱和纠正
第五节 体外循环中的高钠血症
第十二章 酸碱平衡及调节机制
第一节 基本概念
第二节 血液酸碱平衡的常用指标及意义
第三节 体外循环中的酸碱失调
第四节 低温CPB和血气校正
第十三章 抗凝与拮抗
第一节 正常控制凝血的机制
第二节 体外循环中的抗凝和拮抗
第十四章 心血管手术的血液保护
第一节 概述
第二节 血液保护措施
第三节 心脏麻醉与血液麻醉
第十五章 体外循环中的心肌保护
第一节 阻断升主动脉前的心肌保护
第二节 阻断升主动脉后的心肌保护
第三节 开放升主动脉后的心肌保护
第四节 新生儿心肌的保护
第五节 心脏移植的心肌保护
第十六章 体外循环中的脑保护
第一节 CPB心脏手术围术期脑缺血危险因素及预防措施
第二节 体外循环围术期神经精神评价手段
第三节 神经系统保护的措施
第三篇 不同病种体外循环操作
第十七章 先天性心脏病的体外循环
第一节 体外循环计划
第二节 体外循环预充
第三节 体外循环中的监测
第四节 体外循环管理
第五节 特殊病种的体外循环管理
第十八章 心脏瓣膜手术的体外循环
第一节 瓣膜病的病理生理
第二节 瓣膜手术的体外循环
第十九章 冠脉旁路移植术的体外循环
第一节 外科手术
第二节 体外循环管理
第二十章 大血管手术的体外循环
第一节 定义与分类
第二节 体外循环的基本方法
第二十一章 新生儿体外循环
第一节 新生儿体外循环的设备
第二节 新生儿体外循环管理
第二十二章 微创外科的体外循环
第一节 微创体外循环技术
第二节 微创体外循环管理
第二十三章 心脏肿瘤的体外循环
第一节 概况
第二节 外科手术治疗
第三节 体外循环管理
第二十四章 肺栓塞手术的体外循环管理
第二十五章 特殊病种的体外循环
第一节 心脏移植的体外循环特点
第二节 地中海贫血的体外循环
第三节 冷凝集反应阳性患者的体外循环
第二十六章 体外膜式氧合器氧合
附录
附录一 体外循环意外及其对策
附录二 氧合器置换方法及示意图
附录三 阜外医院体外循环常用设备的使用范围
附录四 常用人体检查正常值和体外循环记录单
Book Abstract

第二章 变温系统
第一节 低温在CPB中的应用
〔体外循环中低温的作用〕
CPB术中低温最重要的目的就是提供一定程度的脏器保护,使体外循环更加安全。
l.低温降低氧代谢 机体大部分的生理和生化功能都是在酶促反应下进行的,酶促活动随温度的降低而减弱。在低温状态下,各种耗能减弱,从而使细胞的高能物质得以储存。最明显的机制是减低了代谢率和氧耗量。
2.低温可抑制內源性损伤因子的释放,如自由基、炎性因子等,还能减少兴奋性神经递质的释放,这在中枢神经系统保护中的意义重大。
3.低温CPB可减少灌注流量,增加血液稀释度,降低氧与血流量的比例,同时减少了血液的破坏,减少术后微栓(固体栓子)的发生率,从而起到脏器保护作用。
〔心脏手术对体温的影响〕
1.麻醉对体温的影响 全身麻醉下机体只能通过自主防御反应来调节温度的变化,丧失了通过行为调节体温的能力。全麻药可以剂量依赖方式抑制体温调节,增加热反应阈值。
2.体外循环对体温的影响
(1)转流过程中自然散热。
(2)低温预充液引起体内热量的丢失。
(3)灌注冷心脏停搏液。
(4)体外循环体表和血流降温。
3.其他因素对体温的影响
(1)手术室温度一般维持在24℃左右,患者体表、胸腔、腹腔及脏器长时间暴露于室温当中可引起体温降低。
(2)备皮区使用碘酊、酒精或其他冷消毒液进行皮肤消毒时可使热量丢失。
(3)手术中使用冷液体冲洗体腔,保护脏器或擦拭使用湿敷料垫的温度太低,机械通气时吸入气体的温度和湿度调整不适当及使用时间过长等导致热量丢失。
(4)挥发性麻醉药可经呼吸道携带热量。
〔体外循环期间的降温与复温〕
1.温度监测
(1)鼻咽温度:电极通过鼻孔送至鼻咽部,相当于颅骨底的筛板处。由于此处和大脑血管W小is环相近,一般反映大脑血液流经组织的温度。其温度变化快。
(2)直肠温度:放置电极一定要在直肠的齿状线以上。因为此处血流由髂内血管支配,可反映腹腔脏器温度。其变化速度较慢。
(3)膀胱温度:反映腹腔脏器的温度。将电极板置入导尿管内插入膀胱中。
(4)动脉血温度;是动脉血进入机体前的温度。它主要反映氧合器的变温能力。
(5)静脉血温度:主要反映机体血流丰富器官的温度,如大脑、,心脏、肾脏、肝脏等。根据静脉温度还可判断机体的氧耗情况。
2.体外循环中的体表和血流变温
(1)由于心血管外科手术的复杂性,绝大部分患者需要在低温体外循环下进行,根据手术复杂程度的不同而选择相应的温度。
(2)心肺转流开始后常需要血流及体表同时降温以降低机体氧耗,从而减少重要器官的缺血缺氧性损害。
……

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