直肠温度25℃时停循环选择性脑灌注的探讨  

Selective antegrade cerebral perfusion with a core temperature of 25℃ for aortic arch repair and reconstruction surgery

作　　者：管玉龙[1] 万彩红[2] 董培青[2] 龙村[1] 

机构地区：[1]中国医学科学院协和医学院心血管病研究所阜外心血管病医院体外循环科,北京100037 [2]首都医科大学附属北京安贞医院体外循环科

出　　处：《中华胸心血管外科杂志》2009年第6期390-392,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的对比直肠温度25％与20℃停循环选择性脑灌注技术在主动脉弓部修复重建手术中的临床结果，观察其可行性。方法2006年2月至2008年8月，66例累及主动脉弓部的动脉瘤病人在全身低温停循环选择性脑灌注条件下实施下术。停循环时直肠温度A组为20℃，B组25℃。对比两组CPB参数以及术后恢复过程。结果停循环时鼻咽温度和直肠温度A组显著低于B组（P〈0．001），CPB时间、心肌缺血时间、降温时间、停循环时间、复温时间A组均显著大于B组（P〈0．05）：CPB期间血红蛋白、血浆乳酸水平、围术期用血量、术后清醒及拔除气管插管时间、ICU停留时间、术后24h胸液引流量，两组间差异无统计学意义（P〉0．05）。围术期死亡A组5例，B组1例（P=0．197）。发牛并发症A组13例（39％），B组9例（27％）（P=0．339）。短暂性脑部并发症A组8例，B组3例（P=0．099）。其他各类重要脏器并发症，两组间差异无统计学意义。结论在累及主动脉弓部的动脉瘤手术中，直肠温度维持在25℃停循环选择性脑灌注，可以对中枢神经系统提供保护，亦未增加重要脏器并发症的发生。能否再度提高循环温度进行选择性脑灌注，仍值得探讨。Objective Observations suggested that oxygen supply and blood perfusion to the brain tissue could be mainrained during selective antegrade cerebral perfnsion, as was the hypotbermia in the brain, though deep hypothermic circulatory arrest （DHCA, with rectal temperature of 20℃ ） combined with selective antegrade cerebral perfusion （SACP） has been a safe strategy for aortic arch surgery. The optimal hypothermic temperature for the protection of spinal cord and major visceral organs remains controversial. In this study, SACP with a core temperature of 25℃ was adopted for aortic arch repair and reconstruction surgery. The clinical parameters and outcomes of patients were compared with those of patients who underwent traditional SACP with a core temperature of 20℃. Methods From February 2006 to August 2008, 66 patients underwent aortic arch repair and reconstruction surgery. SACP was implemented when rectal temperature of the patients was reduced to 20℃ in group A （ n = 33） and 25℃ in group B （n =33）. Management of the blood gas and the rewarming strategy were same fur the two groups. The parameters of cardiopulmonary bypass （CPB） and clinical outcomes of patients in group B were compared with those in group A. Results There was no significant difference in the diagnosis, baseline variablesof patients and surgical procedures between the two groups. The durations of CPB, myocardial ischemia, cooling, circulatory arrest and warming was prolonged significantly in group A than those in group B （ P 〈 0.05 ）. There was no significant difference in perioperative haematocrit and plasma concentration of lactate between group A and group B. Five periopcrativc deaths （15%） occurred in group A and only one occurred in group B （3%） （P = 0.197 ）. There was no significant difference in time to regain consciousness, time to extubation and ICU stay between the two groups. Five transient cerebral complications and three cases with permanent cerebral injury occurred in group A, and three t

关 键 词：主动脉 再灌注损伤 低温 选择性脑灌注 

分 类 号：R686[医药卫生—骨科学]