改良pH稳态血气管理+单/双侧选择性脑灌注在全主动脉弓替换术中的应用  

The Strategy of Modified pH-stat and Unilateral vs Bilateral Antegrade Selective Cerebral Perfusion in Total Aortic Arch Replacement

作　　者：杨九光[1] 龙村[1] 黄宇光[2] 田良鑫[3] 孙桂民[1] 赵举[1] 孙立忠[3] 

机构地区：[1]北京阜外心血管病医院体外循环科,北京100037 [2]北京协和医院麻醉科,北京100730 [3]北京阜外心血管病医院血管外科中心,北京100037

出　　处：《中国体外循环杂志》2005年第2期66-69,102,共5页Chinese Journal of Extracorporeal Circulation

基　　金："十五"科技攻关项目:2001BA705B10-7

摘　　要：目的观察深低温时动脉二氧化碳分压(PaCO2)与颈静脉球氧分压(PjvO2)的相关性,评价DebakeyI型主动脉夹层行全主动脉弓替换术中采用改良pH+α稳态血气管理体外循环方法的临床预后。方法16例全主动脉弓替换术病人随机分为单侧或双侧顺行选择性脑灌注组,每组各8例。术中采用改良pH+α稳态血气管理,经氧合器及颈静脉球取血进行血气分析。所有病人均行术前术后认知功能测验等神经精神检查。结果深低温时,PaCO2与PjvO2呈正相关;两组各有1例出现短暂性神经功能异常,两组间认知功能变化无显著性差异。结论1.深低温时,PaCO2与PjvO2呈正相关;2.DebakeyI型主动脉夹层全弓替换术中目前采用的改良pH+α稳态体外循环方法切实可行,临床预后满意。OBJECTIVE The aims of this study are as follows: firstly, to observe the correlation between partial pressure of carbon dioxide in arterial blood (PaCO_2) and the jugular bulb venous oxygen tension (PjvO_2); secondly, to evaluate the outcome of patients with strategy of modified pH-stat combined with alpha-stat, who suffered from Debakey type I aortic dissection and underwent the total aortic arch replacement.METHODS From June 2003 to March 2004, 16 patients who underwent total arch replacement were randomly allocated to one of two methods of brain protection: unilateral (unilateral group, n=8) or bilateral antegrade selective cerebral perfusion (bilateral group,n=8). During the operation, the strategy of modified pH-stat combined with alpha-stat was employed, and blood gas samples were drawn from membrane oxygenator as well as from jugular venous bulb. Preoperative and postoperative neurological examinations, such as cognitive function tests were performed.RESULTS A positive linear relationship between PaCO_2 and PjvO_2 was observed during deep hypothermia (unilateral: r=0.558, P=0.030; bilateral: r=0.560, P=0.046). All patients survived the operations and were discharged from hospital. No new brain infarction occurred. Transient neurologic dysfunction occurred in 1 patient of each group. There were no intergroup differences in the scores of cognitive function decline (unilateral group 5.525±5.6195; bilateral group 8.137±7.4396, P=0.441).CONCLUSION There is a positive relationship between PaCO_2 and PjvO_2. The strategy of pH-stat combined with alpha-stat is practical, feasible, and effective in the surgery of total aortic arch replacement.

关 键 词：体外循环 pH稳态 顺行选择性脑灌注 主动脉弓替换术 脑保护 认知功能测验 

分 类 号：R654.3[医药卫生—外科学]