婴幼儿心脏不停跳和停跳心内直视手术的临床对比
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摘要
目的比较浅低温心脏不停跳和中低温停跳技术在婴幼儿心内直视手术的应用。
方法分析56例3岁以下行心脏手术患者,其中26例(组Ⅰ)在中低温体外循环心脏停跳下手术,30例(组Ⅱ)在浅低温体外循环心脏不停跳下进行手术。比较两组患者的体外循环(CPB)时间、手术时间、术后呼吸机辅助时间、术后低心排发生率、术后严重心律失常发生率、术后住院时间以及死亡率情况。
结果不停跳组患者的体外循环时间和手术时间均较中低温停跳组短(P＜0.01),并且术后呼吸机辅助时间也较停跳组短(P＜0.05);不停跳组患者术后的低心排发生率和严重心律失常发生率均较停跳组低(P＜0.05),并且术后住院时间也较停跳组短(P＜0.05)。
结论浅低温体外循环心脏不停跳技术在婴幼儿心肌保护、改善术后呼吸功能以及促进患者恢复方面均优于中低温体外循环心脏停跳技术。表明浅低温体外循环心脏不停跳可作为一项安全、有效的技术应用于婴幼儿先天性心脏畸形的矫治。
Objective: To compare the effects of mild hypothermia beating-heart cardiopulmonary bypass (CPB) with those of moderate hypothermia arrested-heat CPB in pediatric intracardiac procedure.
Methods: 56 patients whose age were under 3 years underwent open heart surgery. In group 1, 26 patients underwent arrested-heart operation, and in group 2 ,30 patients underwent beating-heart operations.Duration of CPB and surgery ,postoperative mechanical respiratory assistance duration and incidence of low cardiac output, ect ,were compared between the tow groups.
Results: Duration of CPB and operative duration in group 2 were shorter than those in group 1 (P<0.01),and postoperative mechanical respiratory assistance duration was shorter in group 2. The incidence of low cardiac output syndrome and serious cardiac arrhythmia in group 2 was lower than those in group 1, and postoperative residential duration was shorter in group 2.
Conclusion: The effect of mild hypothermia beating-heart CPB is superior to that of moderate hypothermia arrested-heart CPB in pediatric cardiac surgery. Therefore, the mild hypothermia beating-heart CPB is a safe abd effective technique applied to pediatric cardiac surgery.
方法分析56例3岁以下行心脏手术患者,其中26例(组Ⅰ)在中低温体外循环心脏停跳下手术,30例(组Ⅱ)在浅低温体外循环心脏不停跳下进行手术。比较两组患者的体外循环(CPB)时间、手术时间、术后呼吸机辅助时间、术后低心排发生率、术后严重心律失常发生率、术后住院时间以及死亡率情况。
结果不停跳组患者的体外循环时间和手术时间均较中低温停跳组短(P＜0.01),并且术后呼吸机辅助时间也较停跳组短(P＜0.05);不停跳组患者术后的低心排发生率和严重心律失常发生率均较停跳组低(P＜0.05),并且术后住院时间也较停跳组短(P＜0.05)。
结论浅低温体外循环心脏不停跳技术在婴幼儿心肌保护、改善术后呼吸功能以及促进患者恢复方面均优于中低温体外循环心脏停跳技术。表明浅低温体外循环心脏不停跳可作为一项安全、有效的技术应用于婴幼儿先天性心脏畸形的矫治。
Objective: To compare the effects of mild hypothermia beating-heart cardiopulmonary bypass (CPB) with those of moderate hypothermia arrested-heat CPB in pediatric intracardiac procedure.
Methods: 56 patients whose age were under 3 years underwent open heart surgery. In group 1, 26 patients underwent arrested-heart operation, and in group 2 ,30 patients underwent beating-heart operations.Duration of CPB and surgery ,postoperative mechanical respiratory assistance duration and incidence of low cardiac output, ect ,were compared between the tow groups.
Results: Duration of CPB and operative duration in group 2 were shorter than those in group 1 (P<0.01),and postoperative mechanical respiratory assistance duration was shorter in group 2. The incidence of low cardiac output syndrome and serious cardiac arrhythmia in group 2 was lower than those in group 1, and postoperative residential duration was shorter in group 2.
Conclusion: The effect of mild hypothermia beating-heart CPB is superior to that of moderate hypothermia arrested-heart CPB in pediatric cardiac surgery. Therefore, the mild hypothermia beating-heart CPB is a safe abd effective technique applied to pediatric cardiac surgery.
引文
1、龙村主编.体外循环学.北京:人民军医出版社,2004:194.
2、邹刚强,邹湘莉,程兆云.浅低温心脏不停跳在先天性心脏病心内直视手术中的应用[J].实用儿科临床杂志,2006,21(4):253.
3、汪曾伟,刘维永,张宝仁主编.心脏外科学.北京:人民军医出版社,2003:399.
4、顾恺时主编.顾恺时胸心外科手术学.上海:上海科学技术出版社,2003:360.
5、陈如坤主编.临床心胸外科学.北京:人民军医出版社,2003:823.
6、Chiolaro R,Borgeat A,Fisher A.Postoperative arrhythmia and risk factors after open heart surgery.Thoracic Cardiovasc surgeon,1991,39:81-84.
7、赵康丽,虞敏,刘楠,等.心脏外科直视术后心律失常的发生率及其风险因素分析[J].中华心律失常学杂志,2004,8(6):376.
8、Warner K G,Khuri S F,Kloner RA,et al.Structural and metabolic correlates of cell injury in the hypertrophied myocardium during valve replacement[J].J Thorac Cardiovasc Surg,1987,93(5):741-754.
9、吴海波,何学志.浅低温心脏不停跳瓣膜置换手术的生化学研究.医师进修杂志,2005,28(6):13-15.
10、谢晓阳,李朝先,向小勇,等.浅低温体外循环心脏不停跳法对心内直视术中心肌质膜的保护作用.中华实验外科杂志,2001,18(5):473.
11、邱志兵,陈鑫.浅低温体外循环心脏跳动二尖瓣置换心肌保护的体视学研究.中国危重病急救医学,2005,17(9):533-536.
12、陈林,肖颖彬,王学峰,等.先天性心脏病心脏停跳和不停跳下心内直视手术的临床分析[J].第三军医大学学报,2000,22(11):1056-1058.
13、周文富,胡振快,邹玉荣,等.心脏空跳状态下心内手术的麻醉与体外循环管理.中华麻醉学杂志,1996,16(2):599.
14、莫安胜,林辉,何巍,等.浅低温体外循环心脏不停跳心内直视手术中肺保护的临床研究.广西医学,2005,27(6):795-797.
15、Toshihiro O,Yoshiki S,Keishi K,et al.Effect of cardiopulmonary bypassunder temperature on inflammatory reactions[J].Ann Thorac Surg,1997,64(1):124-128.
16、Nappi G,Torella M,Romano G.Clinical evaluation of normothermic cardiopulmonary bypass and cold cardioplegia[J].J Cardiovasc Surg(Torino),2002,43(1):31-36.
17、Ranucci M,SoroG,Frigiola A,et al.Normothermic perfusion and lung function after cardiopulmonary bypass:Effects in pulmonary risk patients[J].Perfusion,1997,12(5):309-315.
18、Mills GH,Khan ZP,Moxham J,et al Effects of temperature on phrenic nerve and diaphragmatic function during cardiac surgery[J].Br J Anaesth,1997,79(6):726-732.
19、Elliott BG.Systemic inflammation.In:Joel A K,David LR,Steven N K.Eds.Cardiac anesthesia.4th end.Philadelphia:W.B.Saunders Company,1999,297-318.
20、杨丽娟,丁敏,王霞,等.心脏不停跳对体外循环术后炎性反应的影响.中国体外循环杂志,2005,3(3):134-135.
21、吴继红,渠川铮.幼儿浅低温不停跳心内直视手术围术期内皮素和肿瘤坏死因子的动态变化观察.宁夏医学院学报,2007,29(1):24-25.
22、李世康,何巍,黄健辉,等.心脏跳动中二尖瓣置换术心肌组织黏附分子的变化.中华胸心血管外科杂志,2006,22(6):404-405.
23、何巍,林辉,陈铭伍,等.心脏跳动中二尖瓣置换术[J].中华胸心血管外科杂志,1996,11(1):678-753.
1.Warner KG,Khuri SF,Kloner RA,et al.Structural and metabolic correlates of cell injury in the hypertrophied myocardium during valve replacement[J].J Thorac Cardiovasc Surg,1987,93(5):741-754.
2.林辉,何巍,韦世锋,等.逆行灌注心脏跳动中主动脉瓣膜替换[J].广西医科大学学报,1996,13(1):427.
3.何巍,林辉,陈铭伍,等.心脏跳动中二尖瓣置换术[J].中华外科杂志,1996,34(6):678-681.
4.肖颖彬,陈林,王学锋,等.浅低温体外循环心脏跳动中心内直视手术1032例临床分析[J].第三军医大学学报,2001,23(5):502-504.
5.张镜芳,庄建,芩坚正,等.应用体外循环主动脉不阻断法施行小儿法乐氏三联症矫治术[J].中华小儿外科杂志,1995,16(6):341-343.
6.顾瑞华,于昂,王仲伦,等.体外循环心脏不停跳心内直视术[J].天津医药,1992,20(2):105-107.
7.何巍,陈铭伍,吴文森,等.浅低温体外循环心脏跳动中行二尖瓣置换术2例.广西医学院学报,1993,10(3):320-321.
8.林辉,蒋宗滨,何巍,等.经冠状静脉窦逆行灌注法在心脏不停跳瓣膜置换术的应用[J].中华麻醉学杂志,1997,17(6):347-349.
9.Batista RJ,Verde J,Nery P,etal.Partial left ventriculectomy to treat end-stage heart disease[J].Ann Thorac Surg,1997,64(3):634.
10.Isomura T.The surgical treatment of dilated myocardiopat-hy(Batista operation)[J].J Card Surg,1999,14(2):124.
11.林辉.心脏不停跳心内直视手术.广西医科大学学报,1999,16(2): 226.
12.李香伟,林辉.浅低温心脏不停跳心内直视手术194例临床报告.广西医学,2003,25(12):2373-2374.
13.林辉,何巍,彭青云,等.逆行灌注心脏不停跳主动脉瓣及联合瓣膜替换术.美国中华医药杂志.1998,4(2):13-15.
14.周文富,胡振快,邹玉荣,等.心脏空跳状态下心内手术的麻醉与体外循环管理.中华麻醉学杂志,1996,16(2):599.
15.林辉,何巍,叶宁,等.心脏不停跳法与温血停搏液连灌法心肌保护作用的研究.中华实验外科杂志,2002,19(3):205-207.
16.何巍,林辉,郑宝石,等.浅低温体外循环心脏跳动中施术对心肌保护的实验研究.中华胸心血管外科杂志,2001,17(2):96-98.
17.肖礼祖.体外循环心肌保护的研究近况.心血管病进展,2002,1(3):178-180.
18.Misar BD,Krukenkamp BD,Lazer ZP,etal.Recovery of postische miccontractile function is depressed by antegrade warm continuous blood cardioplegia.J Thorac Cardivas Surg,1993,105:37-44.
19.Twing W,Spotnitz AJ,Mackenzie TW,etal.Protection of the acutely injured heart deleterious effect of hypothermia.J Surg,1994,56(1):108-111.
20.Rebryka IM,Hanan SA,Borges MR,etal.Rapid cooling contrcacture of myocardium.The advers effect of prearrest cardiac hypothermia.J Thorac Cardiovascsurg,1990,100(2):240-249.
21.莫安胜,林辉,何巍,等.浅低温体外循环心脏不停跳心内直视手术中肺保护的临床研究.广西医学,2005,27(6):795-797.
22.陈林,肖颖彬,王学峰,等.先天性心脏病心脏停跳和不停跳下心内直视手术的临床分析[J].第三军医大学学报,2000,22(11):1056-1058.
23.龙村主编.体外循环学.北京:人民军医出版社,2004:174.
24.冼磊,张瑜红,罗玉华,等.体外循环心脏不停跳及停跳手术对SDH、S-GLDH及ALT的影响研究.广西医科大学学报,2006,23(3):399-400.
25.陈林,肖颖彬,王学峰,等.先心病心脏不停跳下心内直视手术(附555例报告)[J].心肺血管病杂志,2001,20(1):16-17.
26.程伟,肖颖彬,陈林,等.浅低温和中低温体外循环在婴幼儿心脏外科的比较[J].第三军医大学学报,2001,23(5):1103-1105.
27.何巍,林辉,陈铭伍,等.心脏跳动中二尖瓣置换术[J].中华胸心血管外科杂志,1996,11(1):678-753.
28.邱立成,王奇,石海燕,等.不停跳心内直视手术对心肌保护的研究[J].武警医学,2007,18(1):17-19.
29.Toshihiro,Wan Y K,LiZL,et al Esmolol protects the myocardium and facilitates direct version in intracardiac operation with a beating heart[J].Circ J,2002,66:715-717.
30.周晓彤,薛涛.浅低温心脏不停跳心内直视手术对心肌酶学和超微结构的影响.江苏医药杂志,2003,29(9):674-675.
31.吴海波,何学志.浅低温心脏不停跳瓣膜置换手术的生化学研究.医师进修杂志,2005,28(6):13-15.
32.谢晓阳,李朝先,向小勇,等.浅低温体外循环心脏不停跳法对心内直视术中心肌质膜的保护作用.中华实验外科杂志 2001,18(5):473.
33.李世康,何巍,陈铭伍,等.逆行灌注心脏不停跳双瓣膜置换术围术期心肌细胞凋亡及Bcl-2,Bax的表达.中国胸心血管外科临床杂志,2006,13(5):360-361.
34.李世康,何巍,陈铭伍,等.逆行灌注心脏不停跳手术对心肌细胞凋亡的影响.中华实验外科杂志,2006,23(12):1567.
35.邱志兵,陈鑫.浅低温体外循环心脏跳动二尖瓣置换术心肌保护的体 视学研究.中国危重病急救医学,2005,17(9):533-536.
36.陈林,肖颖彬,王学峰,等.浅低温体外循环心脏跳动中手术矫治先心病合并重度肺动脉高压[J].第三军医大学学报,2001,23(5):505-507.
37.林辉,温昭科,李香伟,等.心脏不停跳冠状动脉旁路移植同时行主动脉瓣或联合瓣膜替换术(附137例报告)[J].广西医科大学学报2006,23(2):225-227.
38.谢晓阳,李朝先.心脏不停跳心内直视手术[J].重庆医科大学学报,2001,26(1):106-109.
39.阮坚丽,邵冲,谢永明,等.心脏瓣膜置换术后监护(附52例分析)[J].中国血液流变学杂志,2002,12(4):285-292.
40.陈敦敏,房秀生,周天荣,等.新的体外循环心脏跳动中心内直视术[J].重庆医科大学学报,1997,22(4):344-345
41.Cohen G,BorgerMA,Weised RD,etal.Intraoperative myocardial protection:current trends and future perspectives[J].Ann Thorac Surg,1999,68(5):1995-2001.
2、邹刚强,邹湘莉,程兆云.浅低温心脏不停跳在先天性心脏病心内直视手术中的应用[J].实用儿科临床杂志,2006,21(4):253.
3、汪曾伟,刘维永,张宝仁主编.心脏外科学.北京:人民军医出版社,2003:399.
4、顾恺时主编.顾恺时胸心外科手术学.上海:上海科学技术出版社,2003:360.
5、陈如坤主编.临床心胸外科学.北京:人民军医出版社,2003:823.
6、Chiolaro R,Borgeat A,Fisher A.Postoperative arrhythmia and risk factors after open heart surgery.Thoracic Cardiovasc surgeon,1991,39:81-84.
7、赵康丽,虞敏,刘楠,等.心脏外科直视术后心律失常的发生率及其风险因素分析[J].中华心律失常学杂志,2004,8(6):376.
8、Warner K G,Khuri S F,Kloner RA,et al.Structural and metabolic correlates of cell injury in the hypertrophied myocardium during valve replacement[J].J Thorac Cardiovasc Surg,1987,93(5):741-754.
9、吴海波,何学志.浅低温心脏不停跳瓣膜置换手术的生化学研究.医师进修杂志,2005,28(6):13-15.
10、谢晓阳,李朝先,向小勇,等.浅低温体外循环心脏不停跳法对心内直视术中心肌质膜的保护作用.中华实验外科杂志,2001,18(5):473.
11、邱志兵,陈鑫.浅低温体外循环心脏跳动二尖瓣置换心肌保护的体视学研究.中国危重病急救医学,2005,17(9):533-536.
12、陈林,肖颖彬,王学峰,等.先天性心脏病心脏停跳和不停跳下心内直视手术的临床分析[J].第三军医大学学报,2000,22(11):1056-1058.
13、周文富,胡振快,邹玉荣,等.心脏空跳状态下心内手术的麻醉与体外循环管理.中华麻醉学杂志,1996,16(2):599.
14、莫安胜,林辉,何巍,等.浅低温体外循环心脏不停跳心内直视手术中肺保护的临床研究.广西医学,2005,27(6):795-797.
15、Toshihiro O,Yoshiki S,Keishi K,et al.Effect of cardiopulmonary bypassunder temperature on inflammatory reactions[J].Ann Thorac Surg,1997,64(1):124-128.
16、Nappi G,Torella M,Romano G.Clinical evaluation of normothermic cardiopulmonary bypass and cold cardioplegia[J].J Cardiovasc Surg(Torino),2002,43(1):31-36.
17、Ranucci M,SoroG,Frigiola A,et al.Normothermic perfusion and lung function after cardiopulmonary bypass:Effects in pulmonary risk patients[J].Perfusion,1997,12(5):309-315.
18、Mills GH,Khan ZP,Moxham J,et al Effects of temperature on phrenic nerve and diaphragmatic function during cardiac surgery[J].Br J Anaesth,1997,79(6):726-732.
19、Elliott BG.Systemic inflammation.In:Joel A K,David LR,Steven N K.Eds.Cardiac anesthesia.4th end.Philadelphia:W.B.Saunders Company,1999,297-318.
20、杨丽娟,丁敏,王霞,等.心脏不停跳对体外循环术后炎性反应的影响.中国体外循环杂志,2005,3(3):134-135.
21、吴继红,渠川铮.幼儿浅低温不停跳心内直视手术围术期内皮素和肿瘤坏死因子的动态变化观察.宁夏医学院学报,2007,29(1):24-25.
22、李世康,何巍,黄健辉,等.心脏跳动中二尖瓣置换术心肌组织黏附分子的变化.中华胸心血管外科杂志,2006,22(6):404-405.
23、何巍,林辉,陈铭伍,等.心脏跳动中二尖瓣置换术[J].中华胸心血管外科杂志,1996,11(1):678-753.
1.Warner KG,Khuri SF,Kloner RA,et al.Structural and metabolic correlates of cell injury in the hypertrophied myocardium during valve replacement[J].J Thorac Cardiovasc Surg,1987,93(5):741-754.
2.林辉,何巍,韦世锋,等.逆行灌注心脏跳动中主动脉瓣膜替换[J].广西医科大学学报,1996,13(1):427.
3.何巍,林辉,陈铭伍,等.心脏跳动中二尖瓣置换术[J].中华外科杂志,1996,34(6):678-681.
4.肖颖彬,陈林,王学锋,等.浅低温体外循环心脏跳动中心内直视手术1032例临床分析[J].第三军医大学学报,2001,23(5):502-504.
5.张镜芳,庄建,芩坚正,等.应用体外循环主动脉不阻断法施行小儿法乐氏三联症矫治术[J].中华小儿外科杂志,1995,16(6):341-343.
6.顾瑞华,于昂,王仲伦,等.体外循环心脏不停跳心内直视术[J].天津医药,1992,20(2):105-107.
7.何巍,陈铭伍,吴文森,等.浅低温体外循环心脏跳动中行二尖瓣置换术2例.广西医学院学报,1993,10(3):320-321.
8.林辉,蒋宗滨,何巍,等.经冠状静脉窦逆行灌注法在心脏不停跳瓣膜置换术的应用[J].中华麻醉学杂志,1997,17(6):347-349.
9.Batista RJ,Verde J,Nery P,etal.Partial left ventriculectomy to treat end-stage heart disease[J].Ann Thorac Surg,1997,64(3):634.
10.Isomura T.The surgical treatment of dilated myocardiopat-hy(Batista operation)[J].J Card Surg,1999,14(2):124.
11.林辉.心脏不停跳心内直视手术.广西医科大学学报,1999,16(2): 226.
12.李香伟,林辉.浅低温心脏不停跳心内直视手术194例临床报告.广西医学,2003,25(12):2373-2374.
13.林辉,何巍,彭青云,等.逆行灌注心脏不停跳主动脉瓣及联合瓣膜替换术.美国中华医药杂志.1998,4(2):13-15.
14.周文富,胡振快,邹玉荣,等.心脏空跳状态下心内手术的麻醉与体外循环管理.中华麻醉学杂志,1996,16(2):599.
15.林辉,何巍,叶宁,等.心脏不停跳法与温血停搏液连灌法心肌保护作用的研究.中华实验外科杂志,2002,19(3):205-207.
16.何巍,林辉,郑宝石,等.浅低温体外循环心脏跳动中施术对心肌保护的实验研究.中华胸心血管外科杂志,2001,17(2):96-98.
17.肖礼祖.体外循环心肌保护的研究近况.心血管病进展,2002,1(3):178-180.
18.Misar BD,Krukenkamp BD,Lazer ZP,etal.Recovery of postische miccontractile function is depressed by antegrade warm continuous blood cardioplegia.J Thorac Cardivas Surg,1993,105:37-44.
19.Twing W,Spotnitz AJ,Mackenzie TW,etal.Protection of the acutely injured heart deleterious effect of hypothermia.J Surg,1994,56(1):108-111.
20.Rebryka IM,Hanan SA,Borges MR,etal.Rapid cooling contrcacture of myocardium.The advers effect of prearrest cardiac hypothermia.J Thorac Cardiovascsurg,1990,100(2):240-249.
21.莫安胜,林辉,何巍,等.浅低温体外循环心脏不停跳心内直视手术中肺保护的临床研究.广西医学,2005,27(6):795-797.
22.陈林,肖颖彬,王学峰,等.先天性心脏病心脏停跳和不停跳下心内直视手术的临床分析[J].第三军医大学学报,2000,22(11):1056-1058.
23.龙村主编.体外循环学.北京:人民军医出版社,2004:174.
24.冼磊,张瑜红,罗玉华,等.体外循环心脏不停跳及停跳手术对SDH、S-GLDH及ALT的影响研究.广西医科大学学报,2006,23(3):399-400.
25.陈林,肖颖彬,王学峰,等.先心病心脏不停跳下心内直视手术(附555例报告)[J].心肺血管病杂志,2001,20(1):16-17.
26.程伟,肖颖彬,陈林,等.浅低温和中低温体外循环在婴幼儿心脏外科的比较[J].第三军医大学学报,2001,23(5):1103-1105.
27.何巍,林辉,陈铭伍,等.心脏跳动中二尖瓣置换术[J].中华胸心血管外科杂志,1996,11(1):678-753.
28.邱立成,王奇,石海燕,等.不停跳心内直视手术对心肌保护的研究[J].武警医学,2007,18(1):17-19.
29.Toshihiro,Wan Y K,LiZL,et al Esmolol protects the myocardium and facilitates direct version in intracardiac operation with a beating heart[J].Circ J,2002,66:715-717.
30.周晓彤,薛涛.浅低温心脏不停跳心内直视手术对心肌酶学和超微结构的影响.江苏医药杂志,2003,29(9):674-675.
31.吴海波,何学志.浅低温心脏不停跳瓣膜置换手术的生化学研究.医师进修杂志,2005,28(6):13-15.
32.谢晓阳,李朝先,向小勇,等.浅低温体外循环心脏不停跳法对心内直视术中心肌质膜的保护作用.中华实验外科杂志 2001,18(5):473.
33.李世康,何巍,陈铭伍,等.逆行灌注心脏不停跳双瓣膜置换术围术期心肌细胞凋亡及Bcl-2,Bax的表达.中国胸心血管外科临床杂志,2006,13(5):360-361.
34.李世康,何巍,陈铭伍,等.逆行灌注心脏不停跳手术对心肌细胞凋亡的影响.中华实验外科杂志,2006,23(12):1567.
35.邱志兵,陈鑫.浅低温体外循环心脏跳动二尖瓣置换术心肌保护的体 视学研究.中国危重病急救医学,2005,17(9):533-536.
36.陈林,肖颖彬,王学峰,等.浅低温体外循环心脏跳动中手术矫治先心病合并重度肺动脉高压[J].第三军医大学学报,2001,23(5):505-507.
37.林辉,温昭科,李香伟,等.心脏不停跳冠状动脉旁路移植同时行主动脉瓣或联合瓣膜替换术(附137例报告)[J].广西医科大学学报2006,23(2):225-227.
38.谢晓阳,李朝先.心脏不停跳心内直视手术[J].重庆医科大学学报,2001,26(1):106-109.
39.阮坚丽,邵冲,谢永明,等.心脏瓣膜置换术后监护(附52例分析)[J].中国血液流变学杂志,2002,12(4):285-292.
40.陈敦敏,房秀生,周天荣,等.新的体外循环心脏跳动中心内直视术[J].重庆医科大学学报,1997,22(4):344-345
41.Cohen G,BorgerMA,Weised RD,etal.Intraoperative myocardial protection:current trends and future perspectives[J].Ann Thorac Surg,1999,68(5):1995-2001.