深低温停循环和选择性脑灌注在儿童主动脉手术中的对比研究.doc

通信作者：叶茂，电话：（023E-mail：yemao3066@126.com小儿主动脉弓手术中两种脑保护方法的比较 通信作者：叶茂，电话：（023E-mail：yemao3066@126.com 黄贵金 舒仕瑜 徐颖 徐红珍 刘巍 叶茂（400014 重庆，重庆医科大学附属儿童医院麻醉科 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室 重庆市儿童发育重大疾病诊治与预防国际科技合作基地） 【摘要】目的 比较深低温停循环（deep hypothermic circulatory arrest，DHCA）与选择性顺行性脑灌注（selective antegrade cerebral perfusion，SACP）在小儿主动脉弓手术中的应用效果。方法 回顾性分析我院2008年1月至2012年3月60例行主动脉缩窄（coarctation of aorta，CoA）或主动脉弓中断（interrupted aortic arch，IAA）合并心内畸形矫治术患儿的临床资料，根据脑保护方法分为DHCA组（n=23）和SACP组（n=37），对其术中体外循环转流情况和术后恢复情况进行比较。结果 与DHCA组比较，SACP组转流中最低鼻咽温和最低直肠温显著升高（P0.05）；体外循环时间、术后24 h胸腔引流量、术后机械通气时间和ICU停留时间比较，显著降低（P0.05）。两组死亡率、神经系统并发症、急性肾功能衰竭和低心排出量综合征发生率差异无统计学意义（P0.05）。结论 小儿主动脉弓手术中DHCA与SACP的脑保护效果相似。SACP有利于术后呼吸功能的恢复，减轻凝血功能损伤。 【关键词】深低温停循环；选择性顺行性脑灌注；儿童；主动脉弓；脑保护 A comparative study of two cerebral protection strategies during pediatric aortic arch surgery Huang Guijin，Shu Shiyu，Xu Ying，Xu Hongzhen，Liu Wei，Ye Mao（Department of Anesthesiology，Children’s Hospital of Chongqing Medical University Ministry of Education Key Laboratory of Child Development and Disorders Key Laboratory of Pediatrics in Chongqing Chongqing International Science and Technology Cooperation Center for Child Development and Disorders，Chongqing， 400014，China） 【Abstract】Objective To evaluate the efficacy between deep hypothermic circulatory arrest (DHCA) and selective antegrade cerebral perfusion (SACP) used in pediatric aortic arch surgery.Methods Sixty cases undergoing repair of coarctation of aorta or interrupted aortic arch complicated with cardiac monstrosity from January 2008 to March 2012 in our hospital were retrospectively reviewed. They were divided into two groups according to the method of cerebral protection：DHCA group (n=23) and SACP group (n=37). Perioperative variables between the two groups were compared.Results The lowest nasopharyngeal and rectal temperature were significantly higher in SACP group than in DHCA group (P0.05).Significant decreases in CPB time, postoperative intubation time