中度低温联合单侧顺行脑灌注在弓部替换手术中的应用  

Aortic arch replacement using moderate hypothermic circulatory arrest and unilateral selective antegrade cerebral perfusion

作　　者：鲍春荣[1] 梅举[1] 丁芳宝[1] 朱家全[1] 张俊文[1] 张韫佼[1] 黄健兵[1] 张丽[1] 杨琦[1] BAO Chun-rong;MEI Ju;DING Fang-bao;ZHU Jia-quan;ZHANG Jun-wen;ZHANG Yun-jiao;HUANG Jianbing;ZHANG Li;YANG Qi(Department of Cardiothoracic Surgery,Xinhua Hospital,School of Medicine, Shanghai Jiaotong University,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院心胸外科,上海市200092

出　　处：《中国心血管病研究》2019年第2期173-177,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的 研究中度低温停循环联合单侧顺行脑灌注应用于主动脉弓部替换手术的疗效.方法 回顾性分析2008年1月至2018年6月上海交通大学医学院附属新华医院收治的229例行主动脉弓部替换手术患者的临床资料,平均年龄(61.4±6.9)岁,男性166例(72.5%).其中全弓替换152例(66.4%),同时行主动脉根部替换144例(62.9%).应用的循环管理和脏器保护方法是中度低温停循环(moderate hypothermic circulatory arrest,MHCA)联合单侧顺行性脑灌注(unilateral antegrade cerebral perfusion,UACP).右侧腋动脉插灌注管,温度降至(23.5±1.4)℃停循环,开始单侧顺行脑灌注,灌注液温度18℃~22℃、流量5~10ml·kg-1·min1,脑灌注压力50~60 mm Hg.结果 体外循环时间(229±41)min,主动脉阻断时间(152±29)min,停循环时间(45.1±13.3)min.手术死亡17例(7.4%).主要术后并发症包括永久性神经功能障碍(permanent neurologic dysfunction,PND)、一过性神经功能障碍(temporary neurologic dysfunction,TND)、需要透析的急性肾损伤(acute kidney injury,AKI)和延迟拔管(机械通气时间>72 h),发生率分别为2.6%、6.9%、3.9%、17.9%.结论 主动脉弓部替换手术应用MHCA+UACP方法病死率和并发症发生率低,疗效满意.Objective To study the result of aortic arch replacement using moderate hypothermic circulatory arrest and unilateral selective antegrade cerebral perfusion. Methods We retrospectively analyzed the clinical data of 229 patients who underwent aortic arch replacement using moderate hypothermic circulatory arrest and unilateral selective antegrade cerebral perfusion(MHCA+UACP) in our institution from Jan. 2008 to Jun. 2018. The patients were aged 61.4±6.9 years and 72.5%(n=166) were male. There were 72.5%(n=166) total arch replacement and 66.4%(n=152) aortic root replacement. Right axillary artery was cannulated for cardiopulmonary bypass and cerebral perfusion. Core temperature at the onset of MHCA was 23.5±1.4 ℃. Unilateral selective antegrade cerebral perfusion was initiated at 18℃-22℃ at 5-10 mL/kg/min. Flow was adjusted to maintain a cerebral perfusion pressure of 50-60 mmHg. Results Cardiopulmonary bypass time was 229±41 min. Aortic clamp time was 152±29 min. Circulatory arrest time was 45.1±13.3 min. Surgical mortality was 7.4%(n=17). Main complications included permanent neurological disfunction (PND), temporary neurological disfunction (TND), acute kidney injury (AKI) requiring dialysis and delayed extubation(mechanical ventilation time >72 hours). Overall incidence of PND and TND was 2.6% and 6.9%. Overall incidence of AKI requiring dialysis was 3.9%. The incidence of delayed extubation was 17.9%(n=41). Conclusion Aortic arch replacement using MHCA+UACP can be accomplished with excellent results.

关 键 词：主动脉弓替换 低温停循环 顺行脑灌注 

分 类 号：R654.2[医药卫生—外科学]