中度低温单侧顺行脑灌注在急性A型夹层行孙式手术中的应用——单中心回顾分析  

Sun's procedure for acute type A aortic dissection using moderate hypothermia and unilateral selective antegrade cerebral perfusion in38patients--a single centre retrospective analysis

作　　者：陈祥舟[1] 肖颖彬[1] 王咏[1] 文仁国[1] 刘铖宸 刘梅[1] 

机构地区：[1]第三军医大学附属新桥医院全军心血管外科研究所体外循环组,重庆400037

出　　处：《中国体外循环杂志》2016年第2期73-76,67,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的回顾性分析本院采用中度低温停循环(MHCA)结合单侧顺行脑灌注(uSACP)技术在孙式手术中的应用及其安全性。方法从2014年3月至2015年12月,共有38例急性A型夹层患者(男30例,女8例)接受孙式手术治疗,均采用右侧腋动脉插管行MHCA/uSACP。收集患者术后的死亡率,永久性神经系统功能异常(PND)及短暂性神经系统功能异常(TND)发生率,连续性肾脏替代治疗(CRRT)等情况。结果本组患者平均年龄(45.5±8.7)岁,平均体重(70.3±9.5)kg,停循环时平均膀胱温为(23.8±1.7)℃,uSACP平均流量为(9.4±2.3)ml/(kg·min),灌注压力维持在(55.7±12.2)mm Hg,uSACP时间(45.2±5.1)min。术后死亡3例(7.9%),发生PND 2例(5.3%),发生TND 4例(10.5%)并于出院时全部恢复,使用CRRT3例(7.9%),其余患者均顺利出院。结论急性A型夹层患者行孙式手术治疗中,经右侧腋动脉MHCA/uSACP能够取得有效的脑保护效果,中度低温可以避免深低温对机体造成的不利影响。Objective In this study, we aim to evaluate the application and safety of using moderate hypothermic circulatoryarrest（MHCA） and unilateral selective antegrade cerebral perfusion（uSACP） in Sun＇s procedure for acute type A aortic dissection（ATAAD）.Methods From March 2014 to December 2015, 38 patients（30 males 8 females） who underwent Sun＇s procedure withATAAD presented MHCA/ uSACP form right axillary artery cannulation were analyzed retrospectively. Measured outcomes include oper-ative mortality, permanent neurologic deficit（PND）, transient neurologic deficit（TND） and continuous renal replacement therapy（CRRT）.Results The mean age of this series was（45.5±8.7）years, the mean weight（70.3±9.5）kg.Themean target systemic hypo-thermic circulatory arrest temperature was（23.8±1.7）℃.The flow of uSACP varied between 6 to 12（9.4±2.3） ml/（kg·min）, themean pressure of SACP controlled in（55.7±12.2）mm Hg, and the mean time of MHCA/ uSACP（45.2±5.1） min. Operative mortalitywas 7.9%, PND occurred in 2 patients（5.3%） and TND occurred in 4 patients（10.5%）, and CRRT in 3 patients（7.9%）. The ca-ses with TND recovered well without neurologic deficit atdischarge. All other patients survived to hospital discharge.Conclusion Ourapproach for patients who underwent Sun＇s procedure with ATAAD utilizing MHCA/ uSACP via right axillary artery cannulation acquiredeffective neurological and survival outcomes and obviated the adverse impact of deep hypothermic circulatory arrest.

关 键 词：中度低温停循环 单侧顺行脑灌注 孙式手术 脑保护 

分 类 号：R654.3[医药卫生—外科学]