夹层动脉瘤术中脑灌注异常的诊断及处理_临床医学论文.docVIP

夹层动脉瘤术中脑灌注异常的诊断及处理_临床医学论文 夹层动脉瘤术中脑灌注异常的诊断及处理_临床医学论文 作者：万彩红，杨璟，何美玲，韩敬梅，董培青 【摘要】 目的 回顾性分析总结Standford A 型夹层动脉瘤手术时，采用股动脉插管进行体外循环出现脑灌注不良的临床表现、诊断及处理措施。方法 我院1998年5月至2008年5月间325例Standford A 型夹层动脉瘤实施外科手术，其中有198例采用股动脉插管进行体外循环，术中有4例(2.02%)发生脑灌注异常。排除其他因素后予以紧急无名动脉插管恢复脑灌注。4例恢复脑灌注的时间分别为75 min、14 min、24 min、16 min。继续血流降温到深低温进行手术。2例患者进行了上腔静脉逆行灌注脑保护。结果 1例术后永久性中枢神经系统损伤，其余3例清醒时间为(23.98±23.38)h;2例术后未能脱离呼吸机，另 2例机械辅助通气时间为(34.87±22.81)h 。2例痊愈出院;2例死亡，其中1例术后永久性中枢神经系统损伤，术后7 d死亡;1例死于呼吸衰竭。结论 Standford A 型夹层动脉瘤采用股动脉插管进行手术时，术中出现脑灌注异常时应及时作出判断，迅速建立脑灌注，降低死亡率和并发症。 【关键词】 夹层动脉瘤;灌注;脑部并发症;结果 　　Abstract: OBJECTIVE To review the detection and treatment of cerebral malperfusion during surgical repair for acute type A aortic dissecting aneurysm. METHODS Between May 1998 and May 2008, 325 consecutive patients underwent repair of acute type A aortic dissecting aneurysm at our institution. Cerebral malperfusion was demonstrated in 4 cases with arterial access via femoral cannulation. Cerebral perfusion was restored through innominate artery cannulation after excluding error of measurement. The duration of cerebral malperfusion was 75 min,14 min,24 min and 16 min separately.After that adequate cooling was achieved, surgical repairs were performed successfully in all 4 cases.2 cases underwent operative intervention during deep hypothermic circulatory arrest (DHCA)with retrograde cerebral perfusion (RCP). The rewarming procedure was uneventful. All cases weaned from CPB favourably. RESULTS One of patient underwent consistent coma status because of serious cerebral injury. The time of regain consciousness of other 3 cases was 23.98±23.38 h. One of the 3 cases need consistent mechanical ventilation and died from respiratory dysfunction. The duration of mechanical ventilation in other 2 cases was 34.87±22.81 h and the patients discharged successfully. CONCLUSION The occurrence of cerebral malperfusion in patients with acute type A dissecting aneurysm is associated with significant increased risk of in-hospital morta