中低温选择性脑灌注对肝肾功能的影响  

Impact of moderate or deep hypothermic circulatory arrest with selective cerebral perfusion on hepatic and renal function

作　　者：万彩红[1] 刘晓军[1] 韩敬梅[1] 管玉龙[2] 董培青[1] 

机构地区：[1]首都医科大学附属北京安贞医院体外循环科,北京100029 [2]中国医学科学院阜外心血管病医院体外循环科,北京100037

出　　处：《中国体外循环杂志》2010年第2期75-78,共4页Chinese Journal of Extracorporeal Circulation

基　　金：教育部博士点基金(200800231118)

摘　　要：目的对比不同温度全身停循环选择性顺行脑灌注(SACP)技术围术期患者肝肾功能的动态变化。方法 2008年2月至2010年2月,60例累及主动脉弓部的动脉瘤患者在全身低温停循环SACP条件下实施手术。根据停循环时直肠温度不同分为深度低温组(20℃)和中度低温组(25℃),对比两组围术期血清谷丙转氨酶(GPT)、谷草转氨酶(GOT)、总胆红素(TBIL)、直接胆红素(DBIL)、碱性磷酸酶(ALP)、血清尿素氮(BUN)、肌酐(Cr)的动态变化。结果深度低温组体外循环时间、心肌缺血时间、复温时间显著大于中度低温组(P<0.05)。围术期反映肝功能损伤的指标中GOT、TBIL、DBIL在术后24h、48 h显著上升(P<0.05),术后1周逐渐或部分恢复至术前水平。血清BUN在48 h和1周出现升高趋势。血清Cr在术后24 h和48 h升高(P<0.05),术后1周恢复。中度低温停循环的使用对肝脏、肾脏功能没有显著不利影响。结论与深度低温停循环相比,中度低温可以显著缩短体外循环时间,在对中枢神经系统提供保护的同时,并未增加腹腔重要脏器并发症,对肝肾功能没有明显不利影响,可以在主动脉弓部手术中应用。OBJECTIVE Changes of hepatic and renal function in patients undergoimg aortic arch repair and reconstruction surgery was investigated in this study.METHODS From Feb,2008 to Feb,2010,60 patients underwent aortic arch repair and reconstruction surgery.Hypothermic circulatory arrest（HCA） combined with selective antegrade cerebral perfusion（SACP） was implemented when rectal temperature was cooled to 20℃ in group A（n = 32） and 25℃ in group B（n = 28）.Similar blood gas management and rewarming strategy were used.Compare the changes of glutamic pyruvate transaminase（GPT）,glutamic oxalacetic transaminase（GOT）,total bilirubin（TBIL）,direct bilirubin（DBIL）,alkaline phosphatase（ALP）,blood urea nitrogen（BUN） and creatinine（Cr）.RESULTS The duration of ECC,time of myocardial ischemia and rewarming was significant prolonged in group A than those in group B（P〈0.05）.The levels of GOT、TBIL、DBIL and Creatinine increased significantly at 24 hours or 48 hours after surgery（P〈0.05） and restored completely or partly one week later.Plasma BUN intended to increase at 48h or 1 week.There was no significant difference of these parameters between the two groups at same time point.CONCLUSION Compared to DHCA,moderate hypothermic circulatory arrest with ACP may shorten ECC time and could provide satisfied cerebral protection without detrimental effect on hepatic and renal function.It can be adopted for aortic arch repair and reconstruction surgery safely.

关 键 词：主动脉弓 低温 肝脏 肾脏 

分 类 号：R654.1[医药卫生—外科学]