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心臟麻醉再教育part III - 231002 - 121914

This document discusses cardiopulmonary bypass (CPB) and its components. CPB involves diverting blood from the veins to an external heart-lung machine, oxygenating the blood, and returning it to the arteries. This allows for cardiac surgery to be performed on a still, non-beating heart. The key components of CPB are venous cannulation to drain blood from the body, an arterial pump and oxygenator in the heart-lung machine, and arterial line filters before returning blood to the body. Venting of the left ventricle is also required and can be done via the aortic root or pulmonary veins.

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陳永杰
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56 views50 pages

心臟麻醉再教育part III - 231002 - 121914

This document discusses cardiopulmonary bypass (CPB) and its components. CPB involves diverting blood from the veins to an external heart-lung machine, oxygenating the blood, and returning it to the arteries. This allows for cardiac surgery to be performed on a still, non-beating heart. The key components of CPB are venous cannulation to drain blood from the body, an arterial pump and oxygenator in the heart-lung machine, and arterial line filters before returning blood to the body. Venting of the left ventricle is also required and can be done via the aortic root or pulmonary veins.

Uploaded by

陳永杰
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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體外循環

(cardiopulmonary bypass)

使心臟處於無血流進出、靜態的狀態，以利於
心臟手術的執行 !
當心臟處於無血流狀態時 如何不發生心肌缺氧??
1.建置管路 + 2.心肺機(泵)
體外循環的角色

• 靜脈端血流引流至儲存槽

• 進行血液氧合

• 調整電解質及其他化合物

• 調控血液溫度

• 送返血液至動脈端

• 輸送心臟麻痺液
動脈管路設置
Figure 1: Double-arterial
cannulation
technique. Two equally
sized soft cannulas
inserted into the
innominate artery and
the descending aorta
are linked via a Y-
connector.
靜脈管路設置
排放 :血液/氣體
b. LV vent placed via the right superior pulmonary vein:
A cannula is inserted at the junction of the right superior pulmonary vein
with the left atrium and then threaded through the left atrium and MV
into the LV.
This method is used during aortic and MV surgery (especially in the
presence of aortic regurgitation) and for patients with poor LV function.
心臟麻痺液灌流系統
排放 : 氣體/血液

a. Aortic root vent (one limb of the antegrade


cardioplegia cannula): This is the most common
technique used during coronary artery bypass graft
(CABG) surgery. Suction is applied to the antegrade
cardioplegia cannula (directly or via a side branch).
Aortic root venting of the LV is only effective when the
aorta is cross-clamped, when antegrade cardioplegia is
not being administered, and when the aortic root is not
opened.
Aortic cannulation

Venous cannulation

aortic cross clamp

Cardioplegia system

Vent placed
心肺機(泵)
Components of the CPB circuit

1. Venous Reservoir(靜脈血儲蓄槽)

2. Arterial Pump(動脈泵)
2a, Centrifugal Arterial Pump
2b, Roller Arterial Pump

3. Oxygenator(氧合器)

4. Arterial Line Filter(動脈端過濾器)


1

4
3

2
b. LV vent placed via the right superior pulmonary vein:
A cannula is inserted at the junction of the right superior pulmonary vein
with the left atrium and then threaded through the left atrium and MV
into the LV.
This method is used during aortic and MV surgery (especially in the
presence of aortic regurgitation) and for patients with poor LV function.

a. Aortic root vent (one limb of the antegrade cardioplegia cannula): This is the
most common technique used during coronary artery bypass graft (CABG)
surgery. Suction is applied to the antegrade cardioplegia cannula (directly or via
a side branch). Aortic root venting of the LV is only effective when the aorta is
cross-clamped, when antegrade cardioplegia is not being administered, and
when the aortic root is not opened.

c. LV vent placed directly through the LV apex: This is rarely used today
because of difficulty in positioning and bleeding after removal.

d. Vent placed through the left atrial appendage or the top of the left
atrium (into either the left atrium or LV). Rarely used.
Arterial cannula

Venous cannula

Antegrade cardioplegia cannula


Retragrade cardioplegia cannula

LV vent

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