主动脉弓部手术中体外循环管理体会  

Management of cardiopulmonary bypass with hypothermic circulatory arrest during aortic arch surgery

作　　者：王维俊[1] 康丹凤[1] 葛云霞[1] 冯缘[1] 连锋[1] 徐根兴[1] 薛松[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心胸外科,200127

出　　处：《中国综合临床》2011年第12期1253-1256,共4页Clinical Medicine of China

摘　　要：目的总结主动脉弓部手术体外循环（CPB）的管理方法与结果。方法收集并分析2007年3月至2010年5月58例主动脉弓部手术的体外循环资料。急诊手术24例，择期手术34例；半弓置换术39例，全弓置换术19例；经股动脉插管42例，经右锁骨下动脉（RSA）插管16例，其中4例进行脑顺行灌注（ACP）。结果全组平均CPB时间（208．88±136．45）min，脑停循环时间（27．36±11．50）min，停循环时鼻咽温度（16．01±2．67）℃，直肠温度（19．72±2．13）℃，降温时间（50．91±16．89）min，升温时间（88．97±43．68）min；气管插管时间（56．70±45．19）h，监护室（ICU）滞留时间（5．68±5．31）d，住院时间（30．11±22．27）d；急性肾功能衰竭4例，低氧血症19例，截瘫2例，死亡4例，病死率6．90％。全弓置换组较半弓置换组在CPB时间[（262．16±219．97）min与（182．92±53．81）min，t=2．14，P〈0．05]、脑停循环时间[（30．47±15．86）min与（25．85±8．48）min，t=2．40，P〈0．05]、升温时间[（110．00±68．66）min与（78．72±17．31）min，t=2．69，P〈0．05]、术后气管插管时间[（93．95±131．89）h与（38．08±30．70）h，t=2．50，P〈0．05]显著延长；与择期手术组和右锁骨下动脉插管（RSA）组比较，急诊手术组和股动脉插管组有相似趋势，但差异无统计学意义。结论在主动脉弓部手术中采取单纯深低温停循环时，降温应缓慢、充分、均匀；应优先考虑右腋下动脉或RSA插管，以便于较高温度停体循环期间进行ACP，缩短CPB时间，减轻低温损伤；加强CPB细节管理，以利手术安全和术后恢复。Objective To summarize our experience in the management of cardiopulmonary bypass （CPB） with deep hypothermic circulatory arrest （DHCA） during aortic arch surgery. Methods From March 2007 to May 2010,58 consecutive patients, including 24 urgent and 34 selective operations underwent aortic arch surgery. Thirty-nine hemiarch and 19 total aortic arch replacement operations were performed. CPB was established by perfusion through femoral artery （ 42 cases ） and fight subclavian artery （ RSA ） （ 16 cases ）, of which 4 cases were carried out with antegrade cerebral perfusion （ACP）. Results The mean CPB time was （208.88 ± 136. 45 ） min. The mean cerebral circulation arrest was （ 27. 36 ± 11.50） min. Nasopharyngeal and rectal temperature were （ 16. 01 ±2. 67） ℃ and （ 19.72 ±2. 13） ℃ respectively before DHCA was initiated. The mean times for cooling and rewarming were （50. 91 ± 16. 89） min and （88.97 ±43.68） min. The mean time of intubation was （56. 70 ± 45.19 ） h. The time in ICU was （ 5.68 ± 5.31 ） d, and the time of hospitalization was （30. 11 ± 22. 27） d. Acute renal failure, hypoxemia, and paraplegia occurred post-operatively in 4, 19, and 2 patients, respectively. Four patients died post-operatively with a mortality of 6. 90%. Compared with those received hemiarch replacement operation, the patients received total .aortic arch replacement had statistically longer time of CPB （ [ 262. 16 ± 219. 97 ] min vs [ 182. 92 ± 53.81 ] min, t = 2. 14, P 〈 0.05 ）, cerebral circulatory arrest （ [ 30. 47 ± 15.86 ] rain vs [ 25.85 ± 8.48 ] min, t = 2. 40, P 〈 0.05 ）, rewarming （ [ 110.00 ± 68.66 ] min vs [ 78.72 ± 17.31 ] min, t = 2. 69, P 〈 0.05 ）, and intubation （ [ 93.95 ± 131.89 ] h vs [ 38.08 ± 30.70 ] h, t = 2. 50, P 〈 0. 05 ）. There was no significant difference in the times of these procedures between emergency surgery group and elective surgery group, between RSA and femoral artery cannulation groups. Conclusion It is

关 键 词：主动脉弓部手术 体外循环 低温停循环 

分 类 号：R654.1[医药卫生—外科学]