单纯无名动脉灌注的主动脉弓置换术21例  

Pure hmominate artery perfuslon technique in total aortic arch replacement

作　　者：黄方炯[1] 吴强[1] 许尚栋[1] 任长伟[1] 孙东[1] 杨禁非[1] 于建波[1] 刘岳[1] 赖以恒[1] 瑞起金[1] 

机构地区：[1]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华胸心血管外科杂志》2009年第2期107-108,共2页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨主动脉弓置换术中使用单纯无名动脉灌注进行脑保护的安全性和有效性。方法2004年1月至2007年7月，21例主动脉弓置换者使用单纯无名动脉灌注技术进行脑保护，男19例，女2例；年龄29～72岁，平均（46．5±11．4）岁。A型（Stanford分型）主动脉夹层19例，其中7例合并主动脉瓣关闭不全；升主动脉及主动脉弓真性动脉瘤伴降主动脉受累2例。所有病例均在深低温、使用单纯无名动脉选择性脑灌注下进行升主动脉、主动脉弓置换＋降主动脉覆膜支架置入术。同时行Bentall手术6例，David手术1例。结果升主动脉阻断（109．6±29．6）min；体外循环（186．7±56．2）min；最低鼻咽温（19．0±3，3）℃；选择性脑灌注时间（38．3±11．5）min，流量每分钟（6．8±2．6）ml／kg。术后无中枢神经系统并发症。呼吸机辅助（38．6±29．O）h。1例因低心排输出量综合征于术后第5d死亡。术后随访2～45个月，平均（24．0±12．5）个月，无死亡及心脑血管意外发生。结论深低温、单纯无名动脉选择性脑灌注下行主动脉弓置换是安全、有效的。Objective To study the safety and effectiveness of pure innominate artery perfusion technique in total arch replacement. Methods From January 2004 to July 2007, 21 patients received total arch replacement by using pure irmominate artery perfusion technique. Nineteen were male and 2 female. The average age was （46.5 ± 11.4） years （29 - 72 years）. Nineteen patients were type A dissection and 2 patients with aneurysm involving ascending aorta and aortic arch. Among them, 7 patients had moderate to severe aortic regurgitation. Innominate artery was not involved in all patients. All patients received ascending aorta and arch replacement under hypothermia circulation arrest （HCA） with selective ante-grade cerebral perfusion through innominate arter （SAC, P）. Stent elephant trunk technique was used in all patients. Six patients combined with Bentall＇ s operation and David operation was coneomitanted in one patient. Results There was no central nervous system complication postoperatively. Respiratory assist duration was （38.6± 29.0） hours. One patient died of heart failure on the 5th postoperative day. All survival patients were followed （24.0 ± 12.5） months （2 - 45 months）. There was no death or severe complication during follow up. Conclusion Pure innominate artery perfusion technique is safe and effective in total arch replacement.

关 键 词：主动脉瘤 体外循环 心脏外科手术 选择性脑灌注 

分 类 号：R686[医药卫生—骨科学]