主动脉A型夹层外科手术患者的体外循环管理  

Management of cardiopulmonary bypass fortype A aortic dissection surgical operation

作　　者：杨丽娜[1] 汪涛[1] 赵萍[2] 蓝远敏[1] 陈亮[1] 

机构地区：[1]广东省深圳市龙岗区人民医院心胸血管外科,广东深圳518172 [2]广东省深圳市人民医院心外科

出　　处：《中国民康医学》2015年第17期1-3,共3页Medical Journal of Chinese People’s Health

摘　　要：目的回顾并总结A 型夹层外科手术患者的体外循环管理经验.方法：选取收治的36 例行A 型夹层外科手术治疗的患者进行分析.其中行升主动脉置换术15 例,Bentall 术10 例,孙氏手术9 例,二次手术2 例.术中行股动脉及右腋动脉插管或无名动脉插管,股静脉或上、下腔静脉引流,采用冷含血晶体停搏液、常规中低温体外循环,其中11 例采用深低温停循环（deep hypothermic circulatroy arrest,DHCA）以及选择性顺行性脑灌注（selective antegrade cerebral perfusion,SCAP）体外循环灌注方法.结果：体外循环转流时间（216. 90±75. 56） min、心肌阻断时间（116. 43±32. 87） min、深低温停循环时间（30±5. 82） min,重症监护室时间28 -854（261. 03±49. 92） h,院内死亡1 例,余35 例均痊愈出院,出院时心功能NTHAⅠ-Ⅱ级.结论：正确选择体外循环方法及良好的体外循环管理是A 型夹层外科手术成功的保障.上下半身分别灌注可以有效减轻缺血再灌注损伤;停循环期间选择性顺行脑灌注可有效减少中枢神经系统并发症.Objective:To review and summarize managerial experiences of cardiopulmonary bypass (CPB) for type A aortic dissection surgical operation. Methods:36 patients undergoing type A aortic dissection surgical operationswere analyzed. There were15 cases of ascending aortic replacement, 10 cases of Bentall, and 9 cases of Sun's operation. 2 patients suffered from secondary opera-tions. The tubes were put through femoral artery and right axillary artery or innominate artery, and drain was done through femoral vein or superior vena cava and inferior vena cava. Further, cold blood crystalloid cardioplegia and moderate and hypothermic cardiopulmo-nary bypass were used. Among these patients, 11 cases were given deep hypothermic circulatory arrest ( DHCA) and selective cere-bral perfusion (SACP). Results: The mean CPB time was (216. 90±75. 56)min, the mean aortic clamp time was(116. 43±32. 87) min, the mean duration of SACP was(30±5. 82)min, and themean ICU stay time was 28-854 (261. 03±49. 92)h. One died in the hospital, while the other 35 cases were recovered and discharged with cardiac function of NTHA I-II level. Conclusions: The right se-lection of CPB method and good CPB management can ensure the successful type A aortic dissection surgical operation. Upper and low-er half perfusion can effectively reduce the ischemia reperfusion injury, respectively, and selective cerebral perfusion during the period of circulatory arrest can effectively reduce the complications of central nervous system.

关 键 词：体外循环 主动脉夹层 深低温停循环 选择性脑灌注 

分 类 号：R654[医药卫生—外科学]