杂交手术治疗DeBakeyⅠ型主动脉夹层的体外循环管理  被引量:2

The management of cardiopulmonary bypass in patients with DeBakey type Ⅰ aortic dissection undergoing hybrid procedure

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作  者:吴海卫 张晓华 程晓峰 景华 李德闽 李忠东 董国华 罗立国 申翼 许飚 钱建军 王常田 

机构地区:[1]南京军区南京总院心胸外科,南京210002

出  处:《中国体外循环杂志》2012年第3期151-154,166,共5页Chinese Journal of Extracorporeal Circulation

基  金:南京军区医学科技创新课题项目(10MA090)

摘  要:目的总结杂交手术治疗DeBakeyⅠ型主动脉夹层的体外循环(CPB)的管理方法。方法自2009年1月至2011年6月,我科对56例DeBakey I型主动脉夹层患者行杂交手术治疗,回顾性分析该组患者的CPB方法、神经系统保护策略及治疗结果。术中采用浅低温CPB方法,根据术前脑动脉、主动脉成像(CTA)检查结果,选择单侧顺行脑灌注(UACP)或双侧顺行脑灌注(BACP)联合股动脉插管灌注的方法进行持续灌注,行升主动脉段置换、弓部分支血管重建和主动脉弓降部腔内隔绝,并选择性重建左锁骨下动脉。结果所有56例患者均手术成功,均未采用深低温停循环。术中灌注方法采用BACP+股动脉灌注16例,右侧UACP+股动脉灌注33例,单纯股动脉灌注7例;19例患者行无名动脉、左颈总动脉重建,37例患者行无名动脉、左颈总动脉、左锁骨下动脉重建。CPB时间44~95(65±24)min,主动脉阻断时间32~71(48±29)min,脑灌注时间24~44(32±13)min。术后1例(1.8%)单纯股动脉灌注患者术后出现永久性神经功能障碍,放弃治疗。5例(8.9%)出现一过性神经功能障碍,1例患者死于重度感染,1例患者二次开胸止血,54例患者均痊愈出院。结论杂交手术治疗DeBakeyⅠ型主动脉夹层时,机体无深低温和停循环状态,根据术前检查结果选择个性化的灌注方法,加强围术期CPB管理,可提高神经系统和血液保护效果,显著减少并发症,提高手术成功率。Objective The present study aims to summarize the management and technology of cardiopulmonary bypass (CPB) in patients with DeBakey type Ⅰ aortic dissection undergoing hybrid procedure. Methods From Jan 2009 to Jun 2011, 56 patients suffering from DeBakey Ⅰ aortic dissection underwent hybrid procedure in our department. The clinical data including the methods of CPB, the strategies in nervous system protection and outcome were reviewed retrospectively. During the operation, the conventional CPB was established, and the unilateral antegrade cerebral perfusion (UACP) and/or bilateral antegrade cerebral perfusion (BACP) combined with femoral artery perfusion was applied. The ascending aorta part was replaced, the aortic arch branch vessels were reconstructed, and then a stent graft was implanted covering the aortic arch and part of the descending aorta, and the left subclavian arteries were selectively reconstructed. Results All the patients went through the procedure successfully without deep hypothermic circulatory arrest. BACP combined with femoral artery perfusion was applied in 16 patients, UACP combined with femoral artery perfusion in 33 patients, and 7 perfused with only femoral artery cannulation. Of all the patients, 19 underwent the innominate artery and left common carotid artery reconstruction, and the other 39 patients underwent the innominate artery, the left common carotid artery and the left subclavian artery reconstruction. The cardiopulmonary time was 44 -95 min (mean 65 +24 rain), aortic clamping time was 32 -71 rain (mean 48±29 rain), and the cerebral perfnsion time was 24 -44 min (mean 32±13 rain). One ( 1.8% ) patient who was perfused with only femoral artery cannulation suffered from permanent neurological dysfunction, and 5 (8.9%) had transient neurological dysfunction. One patient died of severe blood infection, 1 patient endured chest re - open because of bleeding, and 54 patients discharged after recovery.Conclusion In the management of CPB during

关 键 词:主动脉夹层 杂交手术 体外循环 脑灌注 

分 类 号:R654.1[医药卫生—外科学]

 

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