改良全弓置换加支架象鼻手术的体外循环管理  

The management of extracorporeal circulation in modified total arch replacement combined with stented elephant trunk

作　　者：曾艳红[1] 王志维[2] 詹玮玮[1] 吴红兵[2] 张敏[2] 

机构地区：[1]三峡大学第三临床医学院葛洲坝中心医院麻醉科,湖北宜昌443002 [2]武汉大学人民医院心血管外科,430060

出　　处：《中国医师进修杂志》2015年第8期584-587,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的总结改良全弓置换加支架象鼻手术的体外循环经验。方法58例Stanford A型主动脉夹层患者均行改良全弓置换加支架象鼻手术。针对手术方式的改良，体外循环技术也进行了改进：使用双侧顺行脑灌注脑保护，降温、升温的处理及血液保护方法等。结果患者手术顺利，手术时间248—485（396±67）min，体外循环时间175—260（181±33）min，心肌阻断时间64～104（85±12）min，停循环时间22～48（32±5）min，选择性脑灌注时间26～54（39±7）min。术后呼吸机辅助呼吸时间5．0～35．5（23．0±4．5）h，ICU监护时间24～140（88±12）h。术后短暂性神经功能障碍3例（5．2％，3／58），肾衰竭5例（8．6％，5／58），肺部感染4例（6．9％，4／58）。结论针对改良主动脉全弓置换加支架象鼻手术，采用双侧顺行脑灌注的脑保护等体外循环管理方式，并发症少，病死率低，取得满意的临床结果。Objective To study the clinical experience of extracorporeal circulation management in modified total arch replacement combined with stented elephant trunk. Methods Fifty-eight patients with Stanford A aortic dissection underwent modified total arch replacement combined with stentcd elephant trunk. With the modified surgical technique, the technology of extracorporeal circulation was also modified with bilateral antegrade cerebral perfusion, the management of the temperature and blood protection. Results All patients were operated successfully. The operative time was 248 -485 （396 ±67） min, extracorporeal circulation time was 175 - 260 （181 ± 33） min, cross clamp time was 64 - 104 （85±12） min, stop circulation time was 22 - 48 （32 ± 5） min, and selective cerebral perfusion time was 26 - 54 （39 ±7）min. The ventilator assisted breathing time was 5.0 - 35.5 （23.0 ± 4.5） h, and ICU monitoring time was 24 - 140 （88± 12） h. Postoperative complications included transient neurologic deficit in 3 cases （5.2%, 3/58）, renal dysfunction in 5 case （8.6%, 5/58）, and pulmonary infection in 4 cases （6.9%, 4/58）. Conclusion To modified total arch replacement combined with stented elephant trunk, the modified management of extracorporeal circulation with bilateral antegrade cerebral perfusion, the management of temperature and blood protection, has a low prevalence of morbidity and mortality.

关 键 词：停循环 深低温诱导 体外循环 动脉瘤 夹层 支架 

分 类 号：R614[医药卫生—麻醉学]