单分支覆膜支架治疗StanfordA型主动脉夹层对神经系统的保护作用  

The nervous system protection in the treatment of Stanford type A aortic dissection with individual single - branch stent graft

作　　者：程光存 申运华 严中亚 汤丹丹 程明光 董桂福 蔡燕 姜波 

机构地区：[1]安徽医科大学附属省立医院心脏外科,安徽省心血管病研究所,230001

出　　处：《安徽医学》2013年第8期1078-1081,共4页Anhui Medical Journal

基　　金：安徽省卫生厅科研计划课题(09A006)

摘　　要：目的总结单分支主动脉弓覆膜支架手术治疗Stanford A型主动脉夹层时神经系统保护的经验和方法。方法对26例患者以新型单分支主动脉弓覆膜支架重建主动脉弓部手术治疗。所有患者在体外循环下完成各种以单分支覆膜支架重建主动脉弓部手术,并采用改良心肌保护液灌注,手术均在深低温停循环＋顺行性脑灌注下进行,根据术前脑动脉、主动脉CTA检查结果,选择单侧顺行脑灌注（UACP）或双侧顺行脑灌注联合灌注（BACP）的方法对脑和脊髓组织行持续灌注。结果 26例患者手术均成功,术中神经系统灌注采用BACP＋腋动脉灌注6例,右侧UACP＋腋动脉灌注20例。体外循环平均时间（126.66±11.65）min,主动脉阻断平均时间（56.29±6.26）min。深低温停循环平均时间（26.90±6.02）min,选择性脑灌注平均时间（23.4±11.5）min,停循环最低鼻咽温度平均（16.8±3.8）℃,术后呼吸机辅助平均时间（17.52±5.18）h,术后1例患者出现永久性神经功能障碍患者放弃治疗,5例出现一过性神经功能障碍,5例出现一过性肾功能障碍,无手术中死亡,无术后严重低心排和多脏器功能衰竭,25例患者痊愈出院,术后随访1~25个月,所有患者无新发神经系统功能障碍,术后3个月复查主动脉CTA显示人工血管通畅,6~12个月后恢复正常。结论新型单分支主动脉弓覆膜支架重建主动脉弓部手术治疗DeBakey I型主动脉夹层时,手术中采用深低温停循环及选择性脑灌注的体外循环方法,保证了术中脑和脊髓的持续灌注,降低了患者术后神经系统并发症的发生率,具有良好的神经系统保护效果,值得临床推广应用。Objective To investigate the application of the reconstruction of aortic arch operation by single branch stent grafting in treating Stanford type A aortic dissection and summarize the management experience and methods of the nervous system protection. Methods From October 2009 to April 2013, 26 cases of Stanford type A aortic dissection patients were included in the present study, who received operation treatment by single branch stent grafting for the reconstruction of aortic arch. The operation was performed under cardiopulmonary bypass, with the usage of modified cold cardioplegia perfusion, and under deep hypothermic circulatory arrest plus antegrade cerebral perfusion techniques. According to the results of preoperative cerebral arteries, the aorta CTA examination, anterograde unilateral cerebral perfusion （unilateral antegrade cerebral perfusion, UACP） or bilateral anterograde cerebral perfusion （BACP）combined with perfusion method line continuous perfusion method in the brain and spinal cord tissue were chosen. Results All patients went the procedure successfully. BACP combined with axillary artery perfusion was applied in 6 patients. UACP combined with right axillary artery perfusion was applied in 20 patients. The cardiopulmonary time was （ 126.66 ± 11.65） min, the aortic clamping time was （56.29±6.26） min, the time of DHCA was （ 26.90 ± 6.02） min, and the time of selective cerebral perfusion was （23.4 ± 11.5 ） min. The lowest nasopharyngeal temperature of DHCA was （ 16.8 ± 3.8 ） ℃. After the operation, the time of mechanical ventilation was （ 17.52 ± 5.18 ） h. One patient suffered from permanent nerve dysfunction gave up treatment, transient nerve dysfunction occurred in 5 cases, transient renal dysfunction occurred in 5 cases, no death happened in the operation, no serious postoperative low cardiac and multiple organ function failure occurred, and 25 patients were healed. The patients were followed up 1 to 25 months postoperatively, and there was no newly occurr

关 键 词：Stanford A型主动脉夹层 体外循环 大血管手术 单分支覆膜支架 深低温停循环 选择性脑灌注 

分 类 号：R543.1[医药卫生—心血管疾病]