单泵双／三管及单-双侧选择性脑灌注在全主动脉弓替换术中应用.docVIP

单泵双／三管及单/双侧选择性脑灌注在全主动脉弓替换术中应用 　 作者：杨九光，王立伟，龙村，黄宇光，孙立忠，田良鑫，吕小东 【摘要】 目的评价Debakey I型主动脉夹层行全主动脉弓替换术中采用单泵双／三管体外循环方法的临床预后；比较术中应用单侧顺行选择性脑灌注(ASCP)和双侧ASCP的脑保护效果。方法16例全主动脉弓替换术患者随机分为单侧或双侧顺行选择性脑灌注组，每组各8例。术中采用单泵双管或单泵三管体外循环方法进行灌注。两组均行术前术后神经系统物理检查、颅脑计算机体层摄影（CT）。术中严密观察患者面色、结膜，经颈内静脉球采血样行血气分析。结果两组各有1例出现短暂性神经功能异常，未发现脑奢侈灌注的表现，两组间各阶段颈静脉血氧分压、颈静脉血氧饱和度无显著性差异（Pgt;0.05）。结论①Debakey I型主动脉夹层全弓替换术中目前采用的单泵双/三管体外循环方法操作简便、切实可行，临床预后满意； ②在基底动脉环完整，存在有效侧支循环条件下，单侧ASCP及双侧ASCP均能取得良好的脑保护效果，推荐使用较为简便的单侧ASCP；而当基底动脉环不完整，且无有效侧支循环的情况下，则推荐使用双侧 ASCP。 【关键词】 体外循环;主动脉弓替换术;脑保护;选择性脑灌注 基金项目：“十五”科技攻关项目 　　The Technique of Double/Triple Arterial Lines With Single Pump Head and Unilateral vs Bilateral Selective Cerebral Perfusion in Total Aortic Arch Replacement 　　Abstract: OBJECTIVEThe aims of this study are to evaluate the outcome of patients with technique of double/triple arterial lines with single pump head, who suffered from Debakey type I aortic dissection and to compare the brain protection effect of unilateral and bilateral antegrade selective cerebral perfusion(ASCP) during total aortic arch replacement.METHODS16 patients who　underwent total aortic arch replacement were randomisedly allocated to one of two methods of　brain protection: unilateral (unilateral group, double arterial lines, n=8) or bilateral ASCP (bilateral group, triple arterial lines, n=8). During the operation, the technique of double/triple arterial lines with single pump head was employed. Preoperative and postoperative neurological examinations, such as cognitive function　tests and brain　CT scan were performed. During the operation, the complexion and conjunctiva of patients were monitored. Blood gas samples were drawn from jugular venous bulb.RESULTSAll patients survived the operations and were discharged from hospital. No new brain infarction occurred. Transient neurologic dysfunction occurred in 1 patient of each group. No obvious evidence　of luxury cerebral perfusion was found. There were no intergroup differences in jugular venous oxygen t