主动脉夹层/瘤患者全弓置换象鼻支架置入术中的脑保护方法  

Protection method of brain in whole bow replacement elephant trunk stents implantation in patients with aortic dissection

作　　者：李德茂[1] 宋怡[1] 李家宇[1] 张桂敏[1] 马润伟[1] 

机构地区：[1]昆明医学院第一附属医院,昆明650032

出　　处：《山东医药》2011年第38期1-2,共2页Shandong Medical Journal

基　　金：云南省自然科学基金资助项目(2008ZC123M)

摘　　要：目的探讨全弓置换象鼻支架置入术治疗DebakeyⅠ型主动脉夹层/瘤合并颈内动脉及基底动脉环狭窄患者的脑保护方法。方法 46例DebakeyⅠ型主动脉夹层/瘤合并颈内动脉及基底动脉环狭窄患者,均行全弓置换象鼻支架置入术治疗。根据颈内动脉和基底动脉环的狭窄程度、灌注量和方法将分为A、B1、B2、C1、C2组。A组(颈内动脉狭窄度<50%)行单纯深低温停循环(DHCA)、右腋动脉选择性脑灌注,灌注量为5～10 ml/(kg.min);B1组(颈内动脉狭窄度50%～70%)行DHCA、右腋动脉选择性脑灌注,灌注量为5～10 ml/(kg.min);B2组(颈内动脉狭窄度50%～70%)行DHCA、右腋动脉选择性脑灌注,灌注量为10～15 ml/(kg.min);C1组(颈内动脉狭窄度>70%且合并脑基底动脉环狭窄)行DHCA、右腋动脉选择性脑灌注,灌注量为10～15 ml/(kg.min),C2组(颈内动脉狭窄度>70%且合并脑基底动脉环狭窄)行DHCA、经右腋及左颈总动脉选择性脑灌注,灌注量为10～15 ml/(kg.min)。结果A组0例、B1组3例、B2组0例、C1组3例、C2组0例出现神经系统并发症。B2、C2组患者脑干听神经诱发电位明显低于B1、C1组(P均<0.05)。结论采用全弓置换象鼻支架置入术治疗DebakeyⅠ型主动脉夹层/瘤合并颈内动脉及基底动脉环狭窄时,适当增加DHCA灌注量和行双侧脑灌注,可保护脑功能。Objective To explore the protection method of brain in whole bow replacement elephant trunk stents implantation in patients with Debakey type I aortic dissection merger internal carotid artery and basal arterial circulations narrow.Methods 46 cases of Debakey type I aortic dissection merger internal carotid artery and basal arterial circulations narrow were treated with whole bow replacement elephant trunk stents implacement.They were divided into A,B1,B2,C1,C2 group according to the internal carotid artery and basal arterial circulations narrow degree,perfusion measure and method.Patients in group A and B1 received pure ultra-low temperature and axillary artery perfusion for 5～10 ml/（kg·min）;simple ultra-low temperature and axillary artery perfusion for 10～15 ml/（kg·min）in group B2 and C1,ultra-low temperature and axillary artery,left carotid artery perfusion measure for 10～15 ml/（kg·min）in group C2.Results Neurological complications were detected in 0 case in group A,3 cases in group B1,0 case in group B2,3 cases in group C1,0 case in group C2.The brain stem trigeminal evoked pote of patients in group B2 and C2 was lower than that in group B1 and C1,all P0.05.Conclusion Increasing the perfusion measure and bilateral brain perfusion can protect brain function in whole bow replacement elephant trunk stents implantation in patients with Debakey type I aortic dissection merger internal carotid artery and basal arterial circulations narrow.

关 键 词：主动脉夹层 深低温停循环 脑保护 体外循环 

分 类 号：R654.3[医药卫生—外科学]