主动脉夹层StanfordA型主动脉弓置换加降主动脉支架植入术深低温体外循环麻醉处理  

Aortic dissection Stanford A aortic arch replacement plus aortic stenting deep hypothermic cardiopulmonary bypass anesthesia management strategy

作　　者：廖亿粦[1] 黄典[1] 廖益永[1] 邓靖单 王雄球[1] 

机构地区：[1]广东梅州市人民医院麻醉科,梅州514031

出　　处：《陕西医学杂志》2017年第8期1012-1013,共2页Shaanxi Medical Journal

基　　金：广东省梅州市市级医研类科技计划项目(2014-B-14)

摘　　要：目的:探讨主动脉夹层StanfordA型主动脉弓置换加降主动脉支架植入术深低温体外循环麻醉处理的安全性及处理策略。方法:回顾分析28例行主动脉夹层StanfordA型主动脉弓置换加降主动脉支架植入术患者临床资料,资料显示麻醉方式为静脉复合麻醉+体外循环(深低温)+选择性脑灌注(或无脑灌注)。根据停止体外循环20min内和30min后有无脑灌流,将患者依次分为有灌流组和无灌流组。比较不同情况下,有灌流组和无灌流组患者的近期疗效。结果:低温组停止体外循环在20min以内的患者中,有脑灌注组在近期转归的各项观察指标上与无脑灌注组均无明显差异(P>0.05)。而根据停止循环超过30 min后脑灌流有无分组,两组的近期转归指标差异显著(P<0.05)。结论:主动脉夹层StanfordA型主动脉弓置换加降主动脉支架植入术的麻醉处理采用全静脉麻醉复合深低温下停循环,可以降低了停循环后对机体的不利影响,缩短停机时间,顺利完成手术。减少相关并发症,促进患者恢复。Objective： To investigate the safety and management of aortic dissection with Stanford type A aortic arch replacement and aortic stent implantation under deep hypothermic cardiopulmonary bypass.Methods：A retrospective study of 28 patients with aortic dissection underwent Stanford A aortic arch replacement and aortic stent implantation were performed.Based on different time point of checking cerebral perfusion,those patients were divided into two groups.The short-term clinical outcomes were compared between two groups in different conditions.Results： Within 20 mins of stopping cardiopulmonary bypass,the indexes of short-term outcomes were similar between two groups（P〉 0.05）.But by division of cerebral perfusion more than 30 mints after stopping cardiopulmonary bypass,the indexes of short-term clinical outcomes were significantly different between two groups （P〉0.05）.Conclusion：Applying total venous anesthesia combined with deep hypothermic cardiopulmonary bypass for aortic dissection with Stanford A aortic arch replacement and aortic stent implantation can shorten the deep hypothermic circulatory arrest on the body＇s impact,shorten the cycle time,reduce complications and improve the quality of life of patients.

关 键 词：主动脉疾病/外科学 @主动脉弓置换 @主动脉支架植入术 麻醉 

分 类 号：R543.1[医药卫生—心血管疾病]