【摘要】 本研究的目的是建立心脏直视手术的动物（山羊）模型。动物都在体外循环下,用心脏停跳液冷灌冠状动脉使心脏停跳,对部分动物并加作左心房切开和二尖瓣检测,以及房室压的测定。 本文报道了1984年2月至6月所作的13只山羊的手术。其中6只于手术的当天死亡,7只长期存活,长期存活率约为54％。如果排除因意外失血的2只动物,则长期存活率约为64％。部份采取（第一组,心脏停跳30分钟）或全部采取（第二组,心脏停跳45和60分钟）了上述的保护肺的措施的动物,则能长期存活（第一组的二只,第二组的五只）。由于手术例数少,不能说保护肺的措施有绝对的意义,但却说明了这种措施在心脏直视手术的重要性。在通过体外循环下使心跳停止45分钟的实验后,就不难增加切开左房作二尖瓣检测和房室压力测定,也不难将停跳时间延长至60分钟。 术后当天死亡的六只动物的肺都有严重的实变,而且手术时的下位肺（右侧）更为严重。 本研究所采取的保护肺脏的措施为:体外循环期间,气道压力波动于5～15cmH₂O之间,以利肺的扩张。术后使动物取腹卧位,并常改变其体位,以利胃内气体排除和预防下垂性肺病变。术后使动物取前高后低的倾斜位,以减少胸腔内的血流量,有利于防止肺水肿。更多还原

【Abstract】 The paper is an analysis of the performance of 13 goats subject to open heart surgery. All goats were under cardiopulmonary bypass. The duration of heart arrest by coronary perfusion with cardioplegic solu tion in the first 4 animals was 30 minutes and in the later 9 animals was 45 or 60 minutes. Six of 13 goats died within the first day after operation; long-term survival was achieved in 7 （54%） of the 13 animals. If the two goats which died from accidental hemorrhage were excluded the long-term survival rate would be increasea to 64%. The criteria set for long-term survival were healthysurvival for more than 2 weeks with healing of surgical wound, normal body temperature, respiratory rate and heart rate, normal urine and feces and well nourished and active. In fact, if a goat could survive for more than 2 weeks after operation, it generally lived a much longer time. The first long-term survival goat of the latter group（45 minutes cardiac arrest）has been living for more than 10 weeks until the time of this report.If our measures of lung protection had been fully adopted as was done in the latter group, all animals would have been long-term survivors. Since the number of animals studied is small, the significance of our lung protection measures cannot be statistically evaluated, but our experience showed that these measures proved to be very important in open heart surgery. With the success of management of the 45-minute cardiac arrest during cardiopulmonary bypass it was not difficult to prolong the duration of cardiac arrest up to 60 minutes to allow the addition of left atrium incision fortesting procedures of the mitral valve and to measure atrial and ventricular pressure.Post-mortum studies of the 6dead goats showed that the pathological changes were mainly confined to the lungs. Pulmonary consolidation, most severe on the underside of the lungs, was observed in all cases.Our measures of lung protection were: first, during cardiopulmonary bypass, artificial ventilation was discontinued and the airway was maintained by pressure fluctuating between 5 and 15 cm H₂O which would increase the tendency of expansion of the lung. Second, after operation the animals were put on the abdominal recumbent position with the body inclined to left or right alternating at set time intervals. These would facilitate to expel the gases that collect in the rumen as a conquence of fermentation and protect the lungs from the hydrostatic influence. Third, after operation the animal’s body was inclined with head up and hindlegs down. This would decrease the blood volume in the thoracic cavity thus minimizing the chances of lung edema.更多还原