主动脉弓部手术脑保护效果临床分析.docVIP

主动脉弓部手术脑保护效果临床分析 作者：王军 作者单位：第二军医大学长海医院胸心外科,上海 200433 【摘要】 目的 探讨主动脉弓部手术大脑保护的临床效果。方法 2000年1月至2007年6月间共行主动脉弓部动脉瘤手术118例。全组患者均采用深低温停循环（DHCA）的体外循环方法，大脑保护方法采用逆行灌注（RCP）以及选择性大脑灌注（SCP）。手术种类包括升主动脉和半弓置换76例；升主动脉和全弓置换42例。结果 采用单纯上腔静脉逆行灌注（SVC-RCP）技术57例，采用上、下腔静脉同时灌注（SIVC-RCP）技术11例，采用全身逆行灌注（TBRP）技术9例。采用SCP技术45例，SCP的插管选择为无名动脉14例，左颈总动脉12例，单侧腋动脉灌注24例。体外循环时间81～284min，DHCA时间为9～120（42.3）min，逆行灌注时间为9～110min，顺行灌注时间31～62min。术后发生短暂精神症状9例，肾功能不全9例，呼吸功能不全15例，多脏器功能不全9例。全组早期死亡7例，死亡率为5.9％。结论 DHCA＋RCP及DHCA＋SCP技术均是主动脉弓部手术的有效方法，但后者更适用于复杂的弓部手术。 【关键词】 主动脉弓 深低温停循环 选择性大脑灌注 脑保护 Clinical Experience of Brain Protection for Aortic Arch Operations WANG Jun,XU Zhi-yun,ZOU Liang-jian, CHEN Jia-yi,SHAO Wen-yu,LI Bai-ling,FAN Mei-zhen (Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433，China) Abstract: OBJECTIVE To summarize the clinical experiences of brain protection for aortic arch operations surgery. METHODS From Jan 2000 to june 2007, 118 patients with aortic arch operation were performed under deep hypothermic circulatory arrest (DHCA) for extracorporeal circulation（ECC）with methods of brain protection by retrograde cerebral perfusion (RCP) and antegrade selective cerebral perfusion (SCP). Surgical procedures included ascending aortic and hemiarch grafting in 76 cases. Ascending and total arch grafting in 42 cases. RESULTS In accordance with difference operation, 57 cases used SVC-RCP perfusion, 11 cases used SIVC-RCP perfusion, 9 cases used total body retrograde perfusion (TBRP) and 45 cases used SCP perfusion. The ECC time, DHCA time, RCP time and SCP time of all patients were 81-284 min, 9-120 min, 9-110 min and 31-62 min respectively. After operation, 9 cases had temporary mental anomaly, 9 cases had renal insufficience, 15 cases had respiratory insufficiency, 9 cases had multiple organ failure and 7cases died (operative mortality was 5.9%).CONCLUSION DHCA＋RCP and DHCA＋SCP are