急性Stanford A型主动脉夹层术中的灌注流量  

The study on perfusion flow of cardiopulmonary bypass during acute Stanford type A aoritc dissection procedure

作　　者：刘锋[1] 杨璟[1] 董培青[1] 

机构地区：[1]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所心脏外科危重中心体外循环及机械循环辅助科,100029

出　　处：《中华胸心血管外科杂志》2014年第6期338-341,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨急性StanfordA型主动脉夹层（acute Stanfordtype Aaorticdissection，AAAD）手术中的合理灌注流量。方法40例手术患者采用随机数字表法分为传统灌注流量（A）组和改良灌注流量（B）组。监测两组患者麻醉诱导结束后（T1），最低温时（他），以5ml·kg-1·min-1流量选择性脑灌注时（T3），恢复全身循环3min时（T4），复温10min（T5）和心肺转流（CPB）结束后30min（T6）6个时点大脑中动脉的脑血流速度（Vm）及脑组织氧合指数（TOI）。检测麻醉诱导后（T1）、复温后10min（T5）、停CPB后30min（T6）、术后6h（T7）、术后12h（T8）和术后24h（1、9）的血浆S100蛋白浓度（ng／L）及血乳酸。结果恢复全身循环3min时（T4），双侧大脑中动脉的Vm，A组Vm明显高于B组[左侧：（45．46±8．57）cm／s对（28．72±9．48）cm／s，P〈0．001；右侧：（42．68±6．59）cm／s对（30．94±11．09）cm／s，P〈0．001]。此时点的A组Vm也明显高于其他时间点；T6时点，A组左侧Vm明显低于B组[（29．91±4．64）cm／s对（37．21±6．53）cm／s，P〈0．05]。两组各时间点TOI均在60％以上，无显著降低者（TOI〈35％）。A组S100蛋白T6、T7、T8时点均高于B组，P〈0．05；血乳酸T6时点，高于B组[（4．88±1．62）mmol/L对（3．82±1．48）mmol／L]，P〈0．05。A组患者清醒时间较B组长[（7．36±2．86）h对（5．27±3．11）h]，P〈0．05。复温时间两组间差异无统计学意义[（74．40±18．50）min对（80．21±21．34）min]。结论与传统灌注流量相比，改良灌注流量既可以提供充分脑灌注，又可防止脑过度灌注。Objective To research the reasonable perfusion flow of cardiopulmonary bypass during aortic arch procedure of patients with acute type A aortic dissection. Methods Forty patients suffered from acute Stanford type A aortic dissection had been divided into two groups randomly. Group A named traditional perfusion flow group, group B named modified perfusion flow group. Monitoring cerebral blood flow and cerebral tissue oxygen during ＂deep hyperthermia circulatory arrest and antegrade aelectile cerebral perfusion procedure by transcranial doppler（TCD） and near-infrared spectroscopy （NIRS）. The concentration of S100 protein and lactic acid was measured at six time point. Results Statistical difference of mean blood flow velocity of MCA had been found between two group 3 min after total flow reperfusion. TOI was more than 60% during study in both of groups. S100 protein in group A was significantly higher than group B at T6, T7 and T8. Statistical difference of blood lactic concentration had been found between two groups, （4. 88± 1.62） mmoL/L in group A, （3.83± 1.48） mmol/L in group B, P 〈0.05. Safe consciousness time between two groups was difference, （7.36±2. 86） h in group A and （5.27±3.11 ） h in group B, P 〈 0. 05. Conclusion Compared with the traditional perfusion flow, modified perfusion flow can provide sufficient cerebral perfusion and prevent the ＂luxury perfusion＂.

关 键 词：主动脉 动脉瘤 夹层 心脏外科手术 脑保护 灌注流量 深低温停循环 选择性脑灌注 

分 类 号：R614[医药卫生—麻醉学]