上腔静脉逆行灌注脑保护技术在DeBakeyⅠ型夹层主动脉瘤手术中的应用  

The application of retrograde cerebral perfusion from superior vena cave in DeBakey typeⅠ aortic aneurysm surgery for brain protection

作　　者：陈锁成[1] 丁国文[1] 施益军[1] 宗白鹭[1] 顾海勇[1] 李进[1] 

机构地区：[1]江苏大学附属人民医院心胸外科,镇江212000

出　　处：《中国体外循环杂志》2012年第1期41-44,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的探讨上腔静脉逆行灌注(RCP)脑保护在DeBakeyⅠ型夹层主动脉瘤手术中的效果。方法 46例DeBakeyⅠ型夹层主动脉瘤应用深低温停循环(DHCA)上腔静脉逆行灌注(RCP)脑保护技术,施行Bentall加升主动脉远端置换29例(其中加半弓置换4例,全弓置换加术中支架植入4例,全弓置换加术中支架植入加升主动脉无名动脉旁路移植1例),全弓置换加术中支架植入3例,Cabrol加升主动脉远端置换6例(其中2例加全弓置换加术中支架植入),Wheat手术3例,升主动脉置换5例。结果 44例RCP时间21～112 min,术后清醒时间为1.5～114 h,无神经系统并发症。2例不能脱离体外循环。结论在主动脉瘤手术中采用RCP脑保护,方法简单,易于操作,可相对延长DHCA的安全时限,是行之有效的脑保护方法之一。Objective To investigate the effect of brain protection with retrograde cerebral perfusion from superior vena cave in DeBakey type I aortic aneurysm surgery. Methods The brain protection by deep hypothermia circulatory arrest （DHCA） with retrograde cerebral perfusion （RCP） was applied in 46 patients with DeBakey type Ⅰaortic aneurysm. Bentall procedure and distal ascending aorta replacement was performed on 29 cases （ among them 4 cases underwent semi - aortic arch replacement at the same time, 4 cases underwent total aortic arch replacement and endovascular stent simultaneously, 1 case underwent total aortic arch replacement and endovaacular stent and ascending aortic - innominate artery bypass graft simultaneously） , 3 cases underwent total aortic arch re- placement and endovascular stent at the same time. Cabrol and distal ascending aorta replacement was performed on 6 cases （among them 2 eases underwent total aortic arch replacement and endovascular stent simultaneously） ,3 underwent Wheat procedure and 5 suf- fering from DeBakey type I aortic aneurysm underwent ascending aortic arch replacement. Results The time of RCP was 21 - 112 rain in 44 cases. 44 patients recovered after operation in 1.5 -114 h without neurologie complications. 2 cases could not wean off cardiopulmonary bypass （CPB）. Conclusion The brain protection by RCP is easy to operate in aortic aneurysm, which can improve the safety of DHCA, so it is an effective method for brain protection.

关 键 词：动脉瘤 心血管外科手术 逆行灌注 脑保护 

分 类 号：R654.2[医药卫生—外科学]