选择性顺行脑灌注及主动脉球囊阻断联合中低温停循环在A型主动脉夹层全弓置换术中的应用初探  

Preliminary experience of selective antegrade cerebral perfusion and balloon catheter occlusion of descending aorta and moderate hypothermic circulatory arrest in aortic arch surgery of acute type A aortic dissection

作　　者：张韶鹏 陈彤云[2] 姜楠[2] 陈庆良[2] ZHANG Shao-peng;CHEN Tong-yun;JIANG Nan;CHEN Qing-liang(Graduate School of Tianjin Medical University,Tianjin 300070,China;Department of Cardial Surgery,Tianjin Chest Hospital,Tianjin Institute of Cardiovascular Disease)

机构地区：[1]天津医科大学研究生院,300070 [2]天津市胸科医院心外科,天津市心血管疾病研究所

出　　处：《天津医药》2018年第4期397-400,共4页Tianjin Medical Journal

摘　　要：目的探讨选择性双侧脑灌注及主动脉球囊阻断技术联合中低温停循环技术在A型主动脉夹层手术中的效果及可行性。方法回顾性分析2017年12月—2018年1月收治的10例A型主动脉夹层患者临床资料,患者均在中低温(鼻咽温度28℃)停循环下急诊行经典孙氏手术,术中采用选择性双侧脑灌注技术及主动脉球囊阻断。分析手术时间、停循环时间等指标及术后恢复情况。结果 10例患者中无死亡病例发生,均顺利康复出院。术中停循环时间(8.75±1.48)min,转机时间(153.25±15.27)min,阻断时间(94.62±12.24)min,手术时间(377.62±32.71)min。自体血回输(800.0±86.6)m L,未输注异体红细胞等成分血。1例患者术后发生急性肾功能衰竭,其他患者无严重并发症发生。结论经典孙氏术中采用选择性双侧脑灌注技术及主动脉球囊阻断技术联合中低温停循环技术,可以明显缩短停循环时间及手术时间,术后复苏时间短,神经系统并发症少,手术效果明显,具有一定的临床意义,值得进一步研究。Objective To investigate the feasibility and effect of selective antegrade cerebral perfusion(SACP)and balloon catheter occlusion of descending aorta(BCOD)combined with moderate hypothermic circulatory arrest(MHCA)in the surgical of acute type A aortic dissection(AAAD).Methods The clinical data of 10 patients with AAAD underwent Sun’s surgery procedure in Tianjin Chest Hospital from December 2017 to January 2018 were retrospectively analyzed.All of the patients were treated with classic Sun’s surgery,and SACP+BCOD+MHCA(nasopharyngeal temperature 28℃)were performed in the surgery.Clinical date and postoperative outcomes of 10 consecutive patients were analyzed.Results All the 10 patients were improved or recovered from symptoms.The duration of circulatory arrest,cardiopulmonary bypass,cardiac ischemia and duration of operation were(8.75±1.48)min,(153.25±15.27)min,(94.62±12.24)min and(377.62±32.71)min respectively.The autologous blood transfusion was(800.0±86.6)mL,without allogenic erythrocytes injection.Acute renal failure occurred in 1 patient after operation,and no other significant complications occurred.Conclusion The classic Sun’s surgical procedure with SACP+BCOD+MHCA can shorten the duration of circulatory arrest and operation distinctly.The combination of these techniques results in shorter postoperative recovery time and fewer neurologic complications.Therefore,it is of certain clinical significance and worthy of further study.

关 键 词：心脏外科手术 主动脉夹层 孙氏手术 中低温停循环 选择性脑灌注 主动脉球囊阻断技术 

分 类 号：R654.1[医药卫生—外科学]