深低温停循环上腔静脉逆行灌注在主动脉瘤手术中的应用  

Application of Retrograde Perfusion through Superior Vena Cava during Deep Hypothermia Circulatory Arrest in Operation of Aortic Aneurysm

作　　者：孙衍庆[1] 董培青[1] 杨传瑞[1] 宋瑞[1] 周其文[1] 王京生[1] 

机构地区：[1]北京安贞医院,北京医科大学人民医院

出　　处：《中华胸心血管外科杂志》1994年第1期25-27,64,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：１９９２．９～１９９３．７在深低温停循环（ＤＨＣＡ）连续上腔静脉逆行灌注下行升主动脉瘤及主动脉夹层动脉瘤手术１２例。病变侵及主动脉右弓、主动脉弓或弓降部，包括Ｂｅｎｔａｌｌ手术、高位右弓峡替换１０例；主动脉升、弓、降部替换，头臂动脉移植１例；大动脉炎、升主动脉全长狭窄行长补片成形术１例。病人全部存活。ＤＨＣＡ逆行灌注时间２７～８１ｍｉｎ，病人均于术后４小时内清醒，无神经系统并发症。测定入脑血和出脑血氧含量及乳酸水平，证明逆行灌注期间脑组织有氧利用，乳酸含量增高不明显。本方法延长了单纯ＤＨＣＡ的安全时限，为升主动脉特别是弓部动脉瘤手术提供了安全的保护方法。Twelve patients of ascending aortic aneurysm and aortic dissection have been operated utilizing continuous retrograde cerebral perfusion through superior vena cava during profound hypothermic circulatiory arrest between September 1992 and July 1993.Ten patients underwent Bentall operation and right aortic arch replacement.One underwent replacement of ascending aorta, aortic arch and descending aorta including brachiocephalic artery implantation.Another one was operated by whole aortic arch plasty with long patch for arteritis. There was no operative mortality.The retrograde perfusion time was ranged from 27～81 minutes.All patients awakened within four hours after operation and no nervous system complication.The oxygen content in the perfused blood and returned blood indicates that the brain can make use of oxygen during retrograde perfusion. The lactic acid increased slightly after rewarming. This method offers advantage over previously used aresst circulatory for ascending aortic replacement, particularly in aortic arch operation.and provides brain protection well,which makes a breakthrough at 'the safe time of arrest circulatery'.

关 键 词：主动脉瘤 深低温停循环 外科手术 

分 类 号：R654.3[医药卫生—外科学]