主动脉弓部手术中脑保护技术的应用分析  

Cerebral protection strategies in aortic arch surgery

作　　者：许飚[1] 李德闽[1] 李忠东[1] 胡小南[1] 董国华[1] 张晓华[1] 程晓峰[1] 张利东[2] 周志强[2] 贲艳红[1] 景华[1] 

机构地区：[1]南京军区南京总医院心胸外科,南京医学博士210002 [2]南京军区南京总医院麻醉科,南京210002

出　　处：《医学研究生学报》2010年第8期827-829,共3页Journal of Medical Postgraduates

基　　金：国家自然科学基金(30972969);南京军区医药卫生重点项目(08Z027)

摘　　要：目的涉及主动脉弓部的胸主动脉瘤手术复杂,易发生脑部并发症。文中旨在总结主动脉弓部手术脑保护的经验。方法回顾性分析1998年2月至2010年1月共完成的123例主动脉弓部手术资料。其中12例在单纯深低温停循环(hypothemic circulatory arrest,HCA)下行弓部手术,18例采用HCA逆行脑灌注(retrograde cerebral pevfusion,RCP)行脑保护,72例采用HCA+顺行脑灌注(antigrade cerebral performed,ACP)行脑保护,无HCA升主动脉置换及介入下腔内隔绝杂交手术21例。结果全组病例术后早期死亡12例(9.8%)。病死率由1998年的25.0%降至2009年的4.7%。术后暂时性神经系统功能障碍(transient neurologic deficit,TND)发生率由1998年的41.7%降至2009年的4.7%,平均14.6%。结论无HCA升主动脉置换及介入下腔内隔绝杂交手术能有效地减少主动脉弓部手术后的病死率及TND发生率。Objective Surgical treatment of thoracic aortic aneurysm involving the aortic arch is complicated and prone to cerebral complications.This study was to summarize the experience of cerebral protection during aortic arch surgery.Methods We retrospectively reviewed 123 cases of aortic arch surgery from February 1998 to January 2010,12 performed during hypothermic circulatory arrest（HCA）,18 using HCA and retrograde cerebral perfusion（RCP）,72 using HCA ＋ antigrade cerebral perfusion（ACP）,and 21 by replacing the ascending aorta and endovascular stent-graft placement in the aortic arch without HCA.Results The postoperative mortality decreased from 25% in 1998 to 4.7% in 2009,and the postoperative occurrence of transient neurologic deficit（TND） decreased from 41.7% to 4.7%,averaging at 14.6%.Conclusion The hybrid procedure without HCA could effectively reduce mortality and incidence of TND after aortic arch surgery.

关 键 词：脑保护 主动脉弓部手术 深低温停循环 杂交技术 

分 类 号：R543.1[医药卫生—心血管疾病]