中位阻断并行循环主动脉弓置换术中脑保护.doc

中位阻断并行循环主动脉弓置换术中脑保护 　 作者：张建卿　程兆云　顾以茼　肖明第 　　【摘要】 目的 探讨在全主动脉弓置换手术中采用中位阻断主动脉连续单侧脑灌注对脑功能的保护效果。方法 11例符合条件患者在手术时采用上述方法，术中于不同时相采颈静脉血样做血气分析，并同时做动脉血气分析。记录相应时相脑电波。术后24 h行Glasgow-Pittsburgh评分(GPC评分)。结果 全组心肺转流（CPB）时间(170．0±32．1)min，术中各时相脑电波无明显异常改变，各时相血气分析显示脑组织代谢正常范围(Pgt;0．05)，平均清醒时间(4．8±1．6)h，无围术期死亡，术后CT检查无新发现脑梗死，24 h内有2例一过性智力障碍，性格改变。术后24 h Glasgow-Pittsburgh评分情况(OPC)均为I级。结论 中位阻断主动脉连续单侧脑灌注在全主动脉弓置换手术中可以起到较好的脑保护效果。术后神经系统的紊乱和并发症明显减少。 　　【关键词】主动脉弓置换;中位阻断;并行循环;脑保护 　　 　　 　　【Abstract】 Objective To study the brain function protection effect of mid-position clamping of aortic arch and parallel circulation in the entire arch replacement surgery.Methods 11 patients receiving mid-position clamping of aortic arch and parallel circulation were colleted the neck vein blood sample in different corresponding time to make the analysis,and simultaneously makes the artery analysis.The brain wave was recorded on corresponding time.Glasgow-Pittsburgh grades(OPC)was given 24 hours after operation.Results The CPB time was(170．0±32．1)minutes,in each time the brain wave exceptionally did not change obviously,blood analysis demonstrated the metabolism of brain organization was normal(Pgt;0．05).The average sober time was(4．8±1．6)hours.There was no perioperation death.The CT inspection results showed no recent cerebral infarction.In 24 hours 2 cases of intelligent disorder were investigated.24 hours Glasgow-Pittsburgh grading situation(OPC)was I level.Conclusion The mid-position clamping and continuous single side cerebral complagia is effective method to protect the brain function in the operation of aortic arch replacement.The nervous system disorder and the complication reduce obviously. 　　【Key words】Replacement of the aorta arch;Mid-position clamping;Parallel circulation;Brain protection 　　 　　主动脉弓部手术虽然有多种维持和保护脑血管循环的方法，但都有一定的优点与缺点。脑组织缺血性损害的预防，往往直接影响到手术后果，传统主动脉弓手术脑保护有3个重要方案：深低温停循环(HCT)，选择性顺行脑灌注(ASCP)，逆行脑灌注(RCP)。HCT时间如超过60 min则被认为是危险的，而且再灌注期间亦可发生再灌注损伤。而RCP近来被证明不能对脑组织提供足够的代谢底物。ASCP有双侧ASCP和单侧ASC