主动脉弓部动脉瘤术中灌注效果的监测与评估  

Monitoring and Evaluation on Effect of Intraoperative Perfusion during Aortic Arch Aneurysm Surgery

作　　者：王小龙[1] 方颖慧[1] 王茜[2] 付志达[1] 魏新广 管玉龙[2] 杨九光[2] 姜福清[2] 孙鹏[2] 龙村[2] 姚婧鑫[1] 林栓同 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心血管疾病国家重点实验室,北京100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院体外循环科,北京100037

出　　处：《中国胸心血管外科临床杂志》2016年第6期563-568,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金资助项目(81170233);教育部留学回国人员科研启动基金(2013-LH01)~~

摘　　要：目的研究主动脉弓部动脉瘤术中单泵双管灌注期间的血液灌注状况。方法回顾性分析2012年9月至2014年4月我院实施主动脉弓全弓置换手术37例患者的临床资料,其中女9例、男28例,年龄19.0～72.0（48.1±10.8）岁。患者术中体外循环均采用单泵双管灌注,采用血流检测仪进行上、下半身灌注管路流量监测,经颅多普勒超声和脑血氧饱和度（rSO_2）监测装置实时监测脑组织内的灌注状况。结果 37例患者总体体外循环（CPB）时间为136.0～277.0（195.8±40.5）min,停循环选择性脑灌注时间为5.0～35.0（21.6±5.6）min。降、复温阶段腋动脉插管流量约占全身灌注管路灌注流量的31.5%～40.8%。2例患者停循环期间rSO_2监测和大脑中动脉血流显著低于术前,提高灌注流量至15.0 ml/（kg·min）后监测指标恢复,患者顺利康复;2例类似病例未处理,术后1例死亡,1例有脊髓并发症。结论主动脉弓部动脉瘤术中体外循环单泵双管灌注技术合理有效,脑灌注监测有助于发现术中灌注异常。Objective To monitor the distribution of blood perfusion during aortic arch aneurysm surgery under double arterial lines with single pump. Methods We retrospectively analyzed the clinical data of 37 patients underwent aortic arch repair or reconstruction between September 2012 and April 2014. There were 9 females and 28 males at mean age of 48.1±10.8 years ranging from 19.0-72.0 years.We took double arterial lines with single pump for cardiopulmonary bypass（CPB） during the operation and we monitored the perfusion tube flow of both the upper and lower body by blood flow detector. Cerebral blood perfusion was measured by transcranial cerebral Doppler and near-infrared spectroscopy cerebral oxygen saturation（rSO2）. Results The mean CPB time of all 37 patients was 195.8±40.5 minutes ranging from 136.0-277.0 minutes and the mean duration time of selective antegrade cerebral perfusion（SCAP） was 21.6±5.6 minutes ranging from 5.0-35.0 minutes. During cooling and rewarming phases,the part of blood flow through axillary artery cannulation ranged from 31.5% to 40.8% of the whole body perfusion. The blood flow of SACP was increased to 15.0 ml /（kg · min） in 2 patients with significantly lower rSO2 and middle cerebral artery blood flow during SACP,and they had an uneventful recovery process after surgery. There were another 2 patients recorded abnormal situation of rSO2 without interventions. One patient died and the other one recovered with compications of spinal cord. Conclusions The technique of double arterial lines with single pump is reasonable and effective. The cerebral perfusion monitoring is helpful to detect abnormal perfusion during aortic arch aneurysm surgery.

关 键 词：主动脉弓 缺血 选择性脑灌注 血液分布 氧代谢 

分 类 号：R654.3[医药卫生—外科学]