• 제목/요약/키워드: cardiopulmonary bypass

검색결과 677건 처리시간 0.028초

Risk Factors Associated with Difficult Reversal of Heparin by Protamine Sulfate in Cardiopulmonary Bypass: An Ignored Issue

  • Ku, Min Jung;Kim, Su Wan;Lee, Seogjae;Chang, Jee Won;Lee, Jonggeun
    • Journal of Chest Surgery
    • /
    • 제53권5호
    • /
    • pp.258-262
    • /
    • 2020
  • Background: The aim of this study was to evaluate risk factors associated with difficult heparin reversal by protamine after cardiopulmonary bypass. Methods: Data from 120 consecutive patients who underwent open heart surgery from 2009 to 2017 were retrospectively reviewed. Patients were divided into 2 groups: (1) those in whom complete heparin reversal was achieved after a single infusion of protamine (group A, n=89); and (2) those who required more protamine for heparin reversal (group B, n=31). Results: Female sex, prolonged bypass time (>200 min), long aortic cross-clamping time (>120 min), and a lowest rectal temperature <26℃ were significant predictors of difficult heparin reversal. Larger amounts of fresh frozen plasma and platelet concentrate were transfused in group B than in group A. Conclusion: Surgeons' efforts to reduce operative time and avoid deep hypothermia may be helpful for increasing the likelihood of easy heparin reversal, especially in female patients.

Delayed Ascending Aorta Replacement in Blunt Chest Trauma with Aortic Injury

  • Son, Shin-Ah;Kim, Gun-Jik;Do, Young Woo;Oh, Tak-Hyuk
    • Journal of Trauma and Injury
    • /
    • 제31권1호
    • /
    • pp.24-28
    • /
    • 2018
  • Ascending aortic injury after blunt chest trauma is an emergency condition that requires urgent diagnosis and treatment. The authors report the case of a patient with traumatic ascending aortic injury who received ascending aorta replacement under cardiopulmonary bypass after failure of primary repair.

만성 폐전색증의 폐동맥 색전제거및 내막 절제술;치험 2례 (Thromboendarterectomy for Chronic Pulmonary Embolism under Cardiopulmonary bypass - Report of a Cases -)

  • 이종국;윤치순;김은기
    • Journal of Chest Surgery
    • /
    • 제24권12호
    • /
    • pp.1201-1208
    • /
    • 1991
  • Two successful pulmonary thromboendartectomies were performed. In the first case, it was performed under cardiopulmonary bypass with moderate hypothermia and ventricular fibrillation In the second case, it was done under deep hypothermia and intermittent circulatory arrest. The patients are recovered uneventfully without complication and discharged from the hospital on warfarin. Their symptoms were improved and the follow-up pulmonary perfusion scans revealed no evidence of residual pulmonary embolus in both cases.

  • PDF

초친수성 표면에서 혈장 단백의 흡착 및 혈소판의 변화에 관한 연구 (Blood Protein Adsorption and Platelet Activation on an Ultra-hydrophilic Substrate)

  • 박남희;전배혁;제형곤;이준완;이재원
    • Journal of Chest Surgery
    • /
    • 제40권4호
    • /
    • pp.273-279
    • /
    • 2007
  • 배경: 체외순환으로 발생하는 전신성 염증반응을 줄이기 위해 체외순환 회로의 표면에 초친수성 표면개질을 시행한 후 혈장 단백의 흡착 및 혈소판의 변화를 관찰하였다 대상 및 방법: 60kg 내외의 돼지 10마리를 대상으로 하였다. 체외순환은 좌심방과 상행대동맥에 캐눌라를 거치하여 원심성 바이오펌프를 이용해 2시간 동안 정상체온 하에서 시행하였다. 이때 실험군(n=5)에서는 체외순환회로에 초친수성 표면처리를 하였으며 대조군(n=5)에서는 상용화된 일반적인 튜빙을 사용하였다. 체외순환에 따른 염증반응의 정도를 비교하기 위하여 혈소판 수 및 응집능 검사, 트롬빈-안티트롬빈 복합체 검사, 그리고 혈액 내 총 단백량을 측정하였다. 결과: 양 군에서 모두 혈소판의 수 및 응집능 기능검사에서 유의한 차이를 보이지 않았으며 또한 트롬빈-안티트롬빈 복합체의 농도에서도 두 군 간에 유의한 차이를 보이지 않았다. 그러나 총 단백량의 측정에서는 체외순환 후 대조군에서 실험군에 비해 유의하게 감소되었다. 결론: 초친수성 표면처리는 체외순환 시 혈장 단백의 표면흡착에 따른 혈장 단백의 감소를 줄일 수 있었으나 이로 인한 염증반응의 감소효과는 관찰할 수 없었다.

방사성동위원소 심혈관촬영술을 이용한 개심술 전후의 역행성 심실중격운동에 관한 연구 (Evaluation of Paradoxical Septal Motion Following Cardiac Surgery with Gated Cardiac Blood Pool Scan)

  • 신성해;정준기;이명철;조보연;고창순;서경필
    • 대한핵의학회지
    • /
    • 제19권1호
    • /
    • pp.67-72
    • /
    • 1985
  • The development of paradoxical interventricular septal motion is a common consequence of cardiopulmonary bypass operation. The reason for this postoperative abnormal septal motion is not clear. 41 patients were studied preoperatively and postoperatively with radionuclide blood pool scan to evaluate the frequency of development of paradoxical septal motion with right ventricular volume overload before surgery and the frequency of development of paradoxical septal motion after cardiac surgery with cardiopulmonary bypass, and to evaluate the change of EF related to the development of paradoxical septal motion after cardiac surgery. The results were as follows; 1) 7 of 41 patients with right ventricular volume overload(that is 17%) showed paradoxical septal motion before surgery. But 13 of 34 patients(that is 42%) had paradoxical septal motion after cardiac surgery with cardiopulmonary bypass. So open heart surgery with cardiopulmonary bypass related the development of paradoxical septal motion after surgery. 2) EF significantly decreased in patients who developed paradoxical septal motion after surgery, whereas the EF did not change in the patients who retained normal interventricular septal motion after surgery. So paradoxical septal motion usually reflected some diminution of left ventricular function, immediately after cardiac surgery.

  • PDF

신생아와 유아 심장 수술 시 심폐기회로 충진액의 최소화 (Minimized Priming Volume for Open Heart Surgery in Neonates and Infants)

  • 김웅한;장형우;양성원;조재희;이경훈;백인혁;곽재건;박천수;이정렬;김용진
    • Journal of Chest Surgery
    • /
    • 제42권4호
    • /
    • pp.418-425
    • /
    • 2009
  • 배경: 심장 수술시 체외순환은 불가피하며 이때 발생하는 혈액 희석, 수혈, 염증반응, 부종 같은 부작용을 최소화하기 위해서 초기 충진액을 최소화하려는 많은 노력이 이루어졌다. 저자들은 최근 체외 순환 장비 및 운영방식의 개선으로 몸무게 10 kg 미만의 신생아 및 유아를 대상으로 체외순환 충진액의 양을 140 mL까지 줄일 수 있었으며 기존의 방법과 비교해보고자 하였다. 대상 및 방법: 2007년 7월부터 2008년 6월까지 본원에서 선천성 심장 기형으로 수술받게 될 5 kg 미만의 환아(n=97)를 대상으로 충진액 최소화 기법과 기존의 방법을 병행하여 수술을 시행하였다. 충진액 최소화 기법은, 심폐기 도관을 짧게 하고, 저혈조의 위치를 조절하며, 진공 배액을 사용하는 등 각 요소마다 충진액의 양을 줄일 수 있는 방법 등을 적용하는 것이었다. 연구 기간이 끝나고 난 뒤 후향적으로 체외순환기록지와 의무기록을 확인하였다. 결과: 새로운 충진액 최소화 기법을 사용한 환아는 46명이었으며 기존의 방법을 이용한 환아는 51명이었다. 양 집단에서 환아의 나이, 몸무게, 심페기 가동시간, 최저체온 등에 유의한 차이가 없었다(p>0.05). 그러나 충진액 최소화 기법을 사용한 환아와 기존의 방법을 사용한 환아에서 심폐기 초기 충진액의 총량은 각각 160.3$\pm$14.1 mL, 277.8+58.1 mL로 유의한 차이를 보였으며(p<0.001), 초기 농축적혈구 혼합량은 33.6$\pm$27.2 mL, 115.3$\pm$49.4 mL로 역시 유의한 차이를 보였다(p<0.001).수술 전 혈액검사에서 적혈구용적률은 오히려 충진액 최소화 기법 적용 군에서 평균 29.9%, 기존의 방법 군에서 평균 35.4%로 기존의 방법 군에서 유의하게 높았다(p<0.001). 각 군에 있어서 시행한 수술을 RACHS 카테고리에 의거해 난이도별로 나누었을 때 충진액 최소화기법 사용 군에서 시행한 수술이 기존의 방법 사용 군에서 시행한 수술에 비해 높은 난이도에 더 많이 분포하였다. 두 군 간에 수술 후 사망률이나 신경학적 합병증의 발생률에는 차이가 없었다. 결론: 체외순환 장비 및 운영방식의 개선으로 기존의 방법과 비교하여 획기적으로 초기 충진액 및 수혈을 줄일 수 있었고 체외순환으로 발생할 수 있는 여러 부작용을 최소화 하는데 도움이 될 것으로 생각되며 향후 이 같은 기법의 확대 보급이 필요할 것으로 생각된다.

심장 관상동맥 외과 (The Clinical Summary of the Coronary Bypass Surgery)

  • 정황규
    • Journal of Chest Surgery
    • /
    • 제13권3호
    • /
    • pp.174-185
    • /
    • 1980
  • It was my great nohour that I can be exposed to such plenty materials of the coronary bypass surgery. Here, I am summarizing the xoronary bypass surgery, clinically. The material is serial 101 patients who underwent coronary bypass surgery between July 17, 1979 to November 30, 1979 in Shadyside Hospital, University of Pittsburgh. 1. Incidence of the Atherosclerosis is frequent in white, male, fiftieth who are living in industrialized country. It has been told the etiologic factor of the atherosclerosis is hereditary, hyperlipidemia, hypertension, smoking, drinking, diabetes, obesity, stress, etc. 2. The main and most frequent complication of the coronary atherosclerosis is angina pectoris. Angina pectoris is the chief cause of coronary bypass surgery and the other causes of coronary bypass surgery are obstruction of the left main coronary artery, unstable angina, papillary muscle disruption or malfunction and ventricular aneurysm complicated by coronary artery disease. 3. The preoperative clinical laboratory examination shows abnormal elevation of plasma lipid in 82 patint, plasma glucose in 40 patient, total CPK-MB in 24 patient stotal LDH in 22 patient out of 101 patient. 4. Abnormal ECG findings in preoperative examine were 29.1% myocardial infarction, 25.8% ischemia and injury, 14.6T conduction defect. 5. Also we had done Echocardiography, Tread Mill Test, Myocardial Scanning, Vectorcardiography and Lung function test to get adjunctive benefit in prediction of prognosis and accurate diagnosis. 6. The frequency of coronary atherosclerosis in main coronary arteries were LAD, RCA and Circumflex in that order. 7. The patients' main complaints which were became as etiologic factor undergoing coronary bypass surgery were angina, dyspnea, diaphoresis, dizziness, nausea and etc. 8. For the coronary bypass surgery, we used cardiopulmonary bypass machine, non-blood, diluting prime, cold cardioplegic solution and moderate cooling for the myocardial protection. 9. We got the grafted veins from Saphenous and Cephalic vein. Reversed and anastomosed between aorta and distal coronary A. using 5-0 and 7-0 prolene continuous suture. Occasionally we used internal mammary A. as an arterial blood source and anastomosed to the distal coronary A. and to side fashion. 10. The average cardiopulmonary bypass time for every graft was 43.9 min. and aortic clamp time was 23 minute. We could Rt. coronary A. bypass surgery only by stand by the cardiopulmonary machine and in the state of pumping heart. 11. Rates by the noumbers of graft were as follow : 21.8% single, 33.7% double, 26.7% triple, 13.9% quadruple, 3% quintuple and 1% was sixtuple graft. 12. combined procedures with coronary bypass surgery were 6% aneurysmectomy, 3% AVR, 1% MVR, 13% pacer implantation and 1% intraaortic ballon setting. 13. We could see the complete abolition of anginal pain after operation in 68% of patient, improvement 25.8%, no change in 3.1%, and there was unknown in 3%. 14. There were 4% immediate postoperative deaths, 13.5% some kinds of heart complication, 51.3% lung complications 33.3% pleural complications as prognosis.

  • PDF

인공폐(산화기) 제작과 실험 (Design & Animal Experiment of Artificial Oxygenator)

  • 김형묵
    • Journal of Chest Surgery
    • /
    • 제15권2호
    • /
    • pp.259-265
    • /
    • 1982
  • We have designed a new type of bubble oxygenator (KOREA-KIM VENOTHERM OXYGENATOR) made of PVC sheet and deforming mesh incorporated in the heat exchanger, and evaluated in experimental animal for the analysis of it`s efficiency. The Oxygenator has low priming volume with high flow rate up to 6 L/rain, and efficiency of heat exchanger was excellent as 1-$1.5^{\circ}C.$ using total cardiopulmonary bypass method under moderate to deep hypothermia. Average priming volume of 1317 ml with 30% hemodilution method was perfused with an average of 1.1-3.0 L/min.$M^2$of arterial blood and pure oxygen at a rate of 2-3.4 L/min for 49.6 minutes continuously in average. During total cardiopulmonary bypass, average $PaO_2$ was $159.8{\pm}60$mmHg, $PaCO_2$ $41.0{\pm}3$mmHg respectively under $SaO_2$ over 96% with systolic arterial pressure of 70 mmHg and CVP of 5-10 cm$H_2O$. Plasma free Hemoglobin was $7.0{\pm}4$ mg/dl with 25% drop of hemoglobin and hematocrit at the end of cardiopulmonary bypass. This KKV Oxygenator was observed to have excellent capabillty of oxygen and carbon dioxide gas transfer with small amount of blood trauma, and the efficiency of heat exchanger was satisfactory during cooling and rewarming of the bubbled blood. Disadvantages have included the somewhat poor deforming effect due to loose PVC fiber mesh, the extracompact character of Teflon filters, and the rough inner surface of the heat exchanger copper pipes.

  • PDF

소아개심술 후 시행한 순환보조장치의 임상적 고찰 (Postcardiotomy Mechanical Circulatory Support in Congenital Heart Diseases)

  • 권오춘;이영탁
    • Journal of Chest Surgery
    • /
    • 제33권5호
    • /
    • pp.385-390
    • /
    • 2000
  • Background: To review the experience that used both ventricular assist device(VAD) and extracorporeal membrane oxygenation(ECMO) for children with congential heart disease requiring postcardiotomy mechanical circulatory support. Material and Method: Between March 1993 and May 1995, we applied mechanical assist device using centrifugal pump to the 16 patients who failed to be weaned from cardiopulmonary bypass(n=15) or had been in cardiogenic shock in intensive care unit(n=1). The diagnosis were all congenital heart diseases and the ages of patients ranged from 20 days to 10 years (mean age=2.5$\pm$3.5 years). Result: The methods of mechanical circulatory support were LVAD(n=13), BVAD (n=1), and ECMO(n=2). The mean assist times were 54.0$\pm$23.7 hours. Post-assist complications were in orders: bleeding, acute renal failure, ventricular failure, respiratory failure, infection, and neurologic complication. It was possible for 9 patients(56.3%) to be weaned from assist device and 5 patients(31.3%) were discharged from hospital. There was no statistical significant between hospital discharged group and undischarged group by age, body weight, cardiopulmonary bypass time, and assist time. Conclusion: The ventricular assist device is an effective modality in salvaging the patient who failed to be weaned from cardiopulmonary bypass, but multiple factors must be considered for improving the results of mechanical circulatory support ; such as patient selection, optimal time of starting the assist device, and prevention and management of the complications.

  • PDF