顺行性脑灌注不同流量控制方法的脑保护研究  

The cerebral protection effects of different methods of flow control in antegrade cerebral perfusion

作　　者：潘绪[1] 汤楚中[1] 孙文婷[1] 李寒[1] 迟海涛[1] 张鹏宇[1] Pan Xu Tang Chu-zhong Sun Wen-ting Li I-Ian Chi Hai-tao Zhang Peng-yu(Department of Cardiovascular Disease, Navy General Hospital, Beijing 100048, China)

机构地区：[1]海军总医院心脏中心,北京100048

出　　处：《中国体外循环杂志》2017年第3期133-135,143,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的总结在Stanford A型主动脉夹层术中顺行性脑灌注期间使用不同流量控制方法对患者脑保护的效果。方法回顾性分析2010年10月至2015年8月,70例Stanford A型主动脉夹层患者的临床资料,依据不同的流量控制方法将患者分为3组:T1组(单纯流量控制组),22例,脑灌注流量5~10 ml/(min·kg);T2组(左侧桡动脉压控制组),24例,脑灌注期间维持左侧桡动脉压力40~70 mm Hg;T3组(泵压控制组),24例,脑灌注期间维持泵平均压70 mm Hg。对比患者术后清醒时间、呼吸机辅助时间、短暂性神经系统功能障碍(TND)、永久性神经系统功能障碍(PND)的发生情况。结果 T3组术后患者清醒时间与呼吸机辅助时间、TND与PND发生率均低于T1组与T2组。结论在Stanford A型主动脉夹层术中顺行性脑灌注期间使用泵压控制流量,受到的影响因素较少,脑保护效果确切,操作简单,值得推广。Objective To summarize the cerebral protection effects of selective anterograde cerebral perfusion with different flow control methods for patients suffering from aortic dissection of Stanford type A who received total arch replacement.Methods From October 2010 to August 2015,there were 70 patients suffering from Stanford type A aortic dissection.According to different flow control methods,patients were divided into three groups.T1：22 cases,simple flow control with cerebral perfusion flow of 5-10 ml/min/kg,T2：24 cases,the cerebral perfusion flow was based on the left radial artery pressure ranged from 40 to 70 mm Hg,T3：24 cases,pump pressure control,the average pump pressure was maintained at 70 mm Hg during cerebral perfusion.Time of consciousness after operation,mechanical ventilation time,transient neurological dysfunction rate （TND）,permanent neurological dysfunction rate （PND） were compared among different groups.Results Time of consciousness after operation and mechanical ventilation time in patients received the pump pressure control anterograde cerebral perfusion were shorter,with fewer suffered from TND and PND.Conclusion In patients suffering from Stanford type A aortic dissection who received intraoperative anterograde cerebral perfusion,usage of pump pressure flow control method showed fewer interference factors and better cerebral protection effects,which was simple to deal with and worth promoting.

关 键 词：主动脉夹层 顺行性脑灌注 流量控制 脑保护 

分 类 号：R654.3[医药卫生—外科学]