累及主动脉弓部大血管手术的体外循环经验  

A Clinical Experience on Cardiopulmonary Bypass in Large Artery Operation Involving in Aortic Arch

作　　者：刘少琼[1] 周新民[1] 胡建国[1] 易定武[1] 赵平[1] 周文武[1] 

机构地区：[1]中南大学湘雅二医院胸心外科,湖南长沙410011

出　　处：《中国医师杂志》2004年第7期916-918,共3页Journal of Chinese Physician

摘　　要：目的　探讨累及主动脉弓部大血管手术的体外循环及其脑保护的方法。方法　回顾性分析 5 2例累及主动脉弓部大血管手术的体外循环方法及其临床转归。结果　以浅、中低温常规体外循环为基本方法 ,深低温停循环 13例 ,深低温停循环辅以上腔静脉逆行灌注 12例 ,选择性顺行脑灌注 7例 ,上、下半身分离灌注 2 0例 ;总死亡率为 17 3 %( 9/5 2 ) ,另有 3例出现不同程度的脑部并发症症状。平均体外循环时间 ( 180 6± 5 1 8)min ,平均阻断升主动脉时间 ( 62 4± 61 9)min。结论　在累及主动脉弓部大血管手术中 ,为延长深低温停循环时间 ,提高脑和脊髓保护的效果 ,减少术后并发症 ,应根据不同的病情和手术方式正确地选择灌注方法。Objective To explore the special technique and the brain protection method of cardiopulmonary bypass(CPB) in large artery operation involving in aortic arch. Methods The procedures of cardiopulmonary bypass and the clinical outcome of 52 patients, who received large artery operation involving in aortic arch, were analysed retrospectively. Results The conventional hypothermal cardiopulmonary bypass was performed as basic method in all patients, deep hypothermal circulatory arrest were used in 13 patients, deep hypothermal circulatory arrest plus retrograde cerebral perfusion in 12 cases, selective antegrade cerebral perfusion in 7 cases, and separate perfusion of upper and low body in 20 cases. The total mortality was 17 3%(9/52), and there were 3 patients with the various severitits of cerebral complications. The mean cardiopulmonary bypass time was (180 6±51 8)min and the mean aortic block time was(62 4±61 9)min. Conclusion During the large artery operations involving in aortic arch, in order to prolong the period of deep hypothermal circulatory arrest, improve the effects of brain and spinal protection and minimize operative complications, different perfusion techniques should be employed according to different artery lesions and operative approaches.

关 键 词：主动脉弓部 大血管手术 体外循环 脑保护 

分 类 号：R654.1[医药卫生—外科学]