目的探讨心脏不停跳心内直视手术的方法和意义。方法总结1?106例施行心脏不停跳心内直视手术病例。并行循环者，阻断上、下腔静脉而不阻断升主动脉，不使用心脏停搏液；逆行灌注者，阻断升主动脉后经冠状静脉窦逆行持续灌注机器氧合血，鼻咽温维持在(33±1)℃，均在心脏空跳条件下完成心内直视手术。结果心脏手术完毕即可停机，术后血流动力学平稳，多巴胺用量很少。低心输出量综合征发生率0.45%，无严重心律失常，血尿发生率1.90%～3.41%。血液生化、心肌超微结构检查结果均显示较传统方法好。无1例发生空气栓塞。早期死亡率1.90%(21/1?106例)。结论心脏不停跳法是一种较接近生理状态的心肌保护方法，能最大程度地减少心肌缺血缺氧损伤，避免再灌注损伤，而获得较理想的心肌保护效果。%Objective: To evaluate the clinical experience of open heart surgery with beating heart. Methods: From 1992 to 2000,1?106 patieats received open heart surgery under cardiopulmonary bypass (CPB) with a beating heart. 689 were male and 417 female. Their age ranged from 7 months to 73 years. Correction of congenital heart defects were done in 721 cases, valve replacement,339 cases and others in 46 cases. Results: Pump stopped immediately at end of operation. Only a few patients needed low dose of dopamine to support circulation. The incidence of low cardiac output syndrome was 0.45%(5/1?106).There was no serious arrhythmia and no air embolism. The rate of hemoglobinuria, which was in relation to the time of CPB, was 1.90%～3.41%. There were 21 operative death with a mortalily of 1.9%. Conclusion: Continuously warm blood perfusion on beating heart has good myocardial protective effect which may be attributed to the reduction of ischemic-repeofusion injury.
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