胸主动脉瘤手术不同体外循环方式的应用  

Different patterns of cardiopulmonary bypass for aneurysm of thoracic aorta

作　　者：张玉霞[1] 杨康[1] 唐令凤[1] 廖克龙[1] 

机构地区：[1]第三军医大学西南医院胸心外科,重庆400038

出　　处：《重庆医学》2004年第12期1782-1783,共2页Chongqing medicine

摘　　要：目的　探讨不同部位不同病变程度的胸主动脉瘤手术体外循环方式的选择。方法　体外循环下行胸主动脉瘤手术2 3例 ,其中升主动脉瘤 2 1例 ,包括DebakeyⅠ型夹层动脉瘤 9例 ;降主动脉瘤 2例 ,包括DebakeyⅢb型夹层动脉瘤 1例。全身中低温体外循环 17例 ,浅低温左心转流 2例 ,左心转流合并全身中低温体外循环 1例 ,深低温停循环上腔静脉逆行脑灌注 3例。结果　手术死亡 1例 ,死亡率 4 .3%。因术前合并左心衰 ,肾衰术后 1h死于急性左心衰竭。术后并发症 2例 ,肺部感染 1例 ,肢体功能障碍并肾功能异常 1例 ,经积极治疗均恢复。 3例停循环者除 1例术后 1h死于左心衰另两例均于术后 3～ 6h清醒 ,无神经系统并发症。结论　根据主动脉瘤患者病情严重程度 ,病变部位的不同 ,选择适当的体外循环方式 ,避免循环、中枢神经系统等并发症是手术成功的关键。Objective To study the selection of different cardiopulmonary bypass(CPB), patterns accoding to the location and lesion of aneurysm of throacocic aorta.Methods A total of 23 patients with aneurysm of thoracic aorta were surgically treated.Among them, 21were of ascengding (including 9 DebakeyⅠtype dissecting aneurysm )and 2 descending aortic aneurysm(including 1 Debakey Ⅲb type dissecting aneurysm ).Among them, CPB was used in 17,left heart bypass in 2,CPB combinded with left heart bypass in 1,and deep hypothermia circulatory arrest combinding with retrograde perfusion through superior vena cava to protect the brain in 3.Results One people died, and death rate was 4.3%. One with left heart failure and renal failure died because of acute left heart failure at 1 h afer operation. There were 2 complications.One was pulmonary infection while 1 had both limbs disturbance and renal dysfunction ,but both them got recovery. After circulatory arrest,2 of 3 became consciousness 3-6h after operation and they had no nervous complications. Except one died of left heart failure at 1 h after operation.Conclusion For aneurysm of thoracic aorta correct CPB method should be selected according to the lesions and disease region. To avoid all the complications ,especially circulation and central nervous system complications, is the key to get success.

关 键 词：胸主动脉瘤 体外循环 

分 类 号：R654.3[医药卫生—外科学]