DeBakeyⅠ型主动脉夹层术中双侧脑灌注脑保护的体会  

Experiences of bilateral cerebral perfusion and protection in DeBakey Ⅰ aortic dissection surgery

作　　者：张祖成[1] 江应安[1] 张遵严[1] 王志维[1] 夏军[1] 夏中元[1] 吴红兵[1] 

机构地区：[1]武汉大学人民医院心血管外科,430060

出　　处：《临床外科杂志》2014年第1期47-48,共2页Journal of Clinical Surgery

摘　　要：目的 总结DeBakeyⅠ型主动脉夹层在深低温停循环选择性脑保护下行全弓置换＋支架象鼻术的体外循环及双侧脑保护经验.方法 350例DeBakeyⅠ型主动脉夹层患者,当鼻温降至20℃,肛温〈23℃时暂停下半身体外循环,经头臂动脉、左颈总动脉插入Y形双侧脑灌注管行脑灌注.然后完成支架象鼻、弓部置换术.恢复下半身体外循环,缓慢复温,复温至鼻咽温32℃以上,心脏复跳,辅助循环至停机.结果 体外循环时间（156.24±42.25）min;心肌阻断时间（90.82±17.73）min;脑灌注时间（35.78±10.49）min,停循环时间（19.22±9.56）min;死亡11例,死亡率3.13%.结论 DeBakeyⅠ型主动脉夹层在深低温停循环手术,行双侧顺性脑灌注,能提供满意的脑保护效果,安全、可靠、有效,术后并发症少.Objective To＇summarize the clinical experience of cardiopulmonary bypass（CPB） and bilateral cerebral protection in the total arch replacement combined with stented elephant trunk im- plantation under deep hypothermic circulatory arrest（DHCA） for DeBakey aortic dissection. Methods A total of 350 patients with DeBakey I aortic dissection were enrolled. The CPB was paused when the nose temperature was reduced to 20℃ and the anal temperature was less than 23℃. The Y-shape stent was in- serted through brachiocephalic artery and left common carotid artery for bilateral cerebral perfusion. After total arch replacement combined with stented elephant trunk implantation, the circulation and body temper- ature were slowly recovered. When the nose temperature was raised to 32℃, cardiac reanimation occurred and assisted circulation continued until the end. Results The mean CPB time was （ 156.24 ± 42.25 ） mi- nutes, the mean myocardial ischemia time was（90.82 ± 17.73）minutes, the mean antegrade cerebral per- fusion （ACP）time was （35.78 ± 10.49 ）minutes, and lower body circulatory arrest（CA） time was （19.22 ± 9.56） minutes. The in-hospital mortality was 3.13% （11/350）. Conclusion Bilateral antegrade cerebral perfusion under DHCA can attain satisfactory cerebral protection during DeBakey I aortic dissection sur- gery. It is safe,reliable and effective with less postoperative complications.

关 键 词：深低温停循环 双侧脑灌注 主动脉夹层 

分 类 号：R655[医药卫生—外科学]