主动脉弓部手术脑保护的临床应用  

Brain Protection during Aortic Arch Operations

作　　者：刘炜[1] 支惠珍[1] 李淑红[1] 涂艳琴[1] 徐建军[1] 

机构地区：[1]南昌大学第二附属医院手术室,南昌330006

出　　处：《南昌大学学报（医学版）》2010年第10期79-81,共3页Journal of Nanchang University：Medical Sciences

摘　　要：目的评价主动脉弓部手术脑保护的临床应用。方法对2007年1月至2010年8月17例行主动脉弓部动脉瘤手术患者行升主动脉人造血管置换,Bentall手术采用升主动脉-右房插管、中低温体外循环（extracorporeal circulation,ECC）;升主动脉及半弓置换手术采用腋动脉-右房插管、深低温停循环（deep hypothermic circulatory arrest,DHCA）的方法;全主动脉弓置换（象鼻术）＋带膜支架植入手术采用腋动脉-右房插管、深低温停循环＋顺行性脑灌注方法。心肌保护均采用4∶1含血冷搏液顺行＋逆行方法灌注。结果升主动脉及半弓置换3例,Bentall手术10例,Bentall＋升主动脉及半弓置换2例,全主动脉弓置换（象鼻术）＋带膜支架植入手术2例。采用腋动脉插管5例。ECC时间112~386（178.3±52.6）min,升主动脉阻断时间65~248（135.0±35.0）min,最低鼻咽温15.8~27.6（22.5±3.3）℃。DHCA 5例,时间为26~55（27.3±11.5）min,转中尿量150~2 900（1 352.6±1 062.3）mL,超滤量500~3000（1783.9±1246.6）mL。术后发生肾功能不全1例,2次行开胸止血1例,无手术死亡。17例患者未发生精神症状及其他大脑并发症。结论针对不同主动脉弓部手术选择不同ECC方法并加强围手术期ECC管理可以显著减少并发症的发生,提高手术成功率。Objective To evaluate the clinical application of brain protection in aortic arch surgery.Methods From January 2007 to August 2010,17 patients with aortic aneurysm underwent aortic arch operations.Moderate hypothermic extracorporeal circulation（ECC） was used for ascending aorta replacement and Bentall operation.Deep hypothermic circulatory arrest（DHCA） was used for ascending aorta-hemiarch replacement.DHCA with antegrade selective cerebral perfusion was used for total aortic arch replacement with stented elephant trunk implantation.The myocardium was protected with cold antegrade and retrograde blood cardioplegia（4∶1）.Right auxiliary artery cannulation was routinely used for aortic arch operations.Results Among the 17 patients,ascending aorta-hemiarch replacement was performed in 3 patients,Bentall operation in 10 patients,Bentall operation with ascending aorta-hemiarch replacement in 2 patients,total aortic arch replacement with stented elephant trunk implantation in 2 patients,and axillary artery cannulation in 5 patients.The ECC time was（178.3±52.6） minutes（range 112 to 386 minutes）,aortic clamp time was（135.0±35.0） minutes（range 65 to 248 minutes）,and the lowest nasopharyngeal temperature was（22.5±3.3）℃（range 15.8 to 27.6 ℃）.DHCA was used in 5 patients.The arrest circulation time was（27.3±11.5） minutes（range 26 to 55 minutes）,urine output during DHCA was（1 352.6±1 062.3）mL（range 150 to 2 900 mL）,and ultrafiltration volume was（1 783.9±1 246.6） mL（range 500 to 3 000 mL）.After operation,1 case had renal insufficiency and 1 case underwent thoracotomy twice to stop bleeding.No deaths and no psychotic and cerebral complications occurred in all patients.Conclusion In order to decrease the complications and ensure successful operation,appropriate ECC method must be selected and perioperative ECC managemen should be strengthened.

关 键 词：主动脉弓 深低温停循环 选择性大脑灌注 脑保护 

分 类 号：R654.1[医药卫生—外科学]