Stanford A型主动脉夹层手术中不同脑灌注方式的脑保护效果研究  

Cerebral protective effects of different cerebral perfusion methods in Stanford A aortic dissection surgery

作　　者：孙煦 朱悦倩 安静 任云 姚昊[1] Sun Xu;Zhu Yueqian;An Jing;Ren Yun;Yao Hao(The Second Affiliated Hospital of Nanjing Medical University, Jiangsu Nanjing 210000,China)

机构地区：[1]南京医科大学第二附属医院,南京210000

出　　处：《中国体外循环杂志》2019年第2期72-75,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的在Stanford A型主动脉夹层手术中,不同脑灌注方式对患者脑保护的临床效果进行对比分析。方法回顾性分析2016年1月至2018年5月期间在本院手术的149例急性Stanford A型主动脉夹层患者,根据术中脑灌注方式分为两组,A组(n=102)采用经右侧腋动脉顺行脑灌注(ACP)行脑保护,R组(n=47)经上腔静脉逆行脑灌注(RCP)行脑保护。对两组患者术前一般情况、手术时间、体外循环时间、主动脉阻断时间、停循环时间、脑灌注时间、术后清醒时间、机械通气时间、监护室停留时间、输血量、短暂性神经功能障碍、永久性神经功能障碍等进行比较。结果与A组比较,R组停循环时间、脑灌注时间明显较长(P <0.05);而两组在其他方面的比较均无统计学意义(P≥0.05)。结论 RCP与ACP均能为Stanford A型主动脉夹层手术提供有效的脑保护,临床效果无明显差异。Objective The clinical effects of different cerebral perfusion methods on patients with Stanford A aortic dissection were compared and analyzed. Methods A retrospective analysis of 149 patients with acute Stanford A aortic dissection in our hospital from January 2016 to May 2018 was performed. Patients were divided into two groups according to intraoperative cerebral perfusion methods. Group A( n = 102) used antegrade cerebral perfusion( ACP) for brain protection,while group R( n = 47) used retrograde cerebral perfusion( RCP). General condition of the two groups,time of the operations,time of cardiopulmonary bypass( CPB),interruption time of the aorta,time of deep hypothermic circulatory arrest,time of cerebral perfusion,awakening time after the operations,time of mechanical ventilation,length of ICU stay,the amount of blood transfusion,and incidences of temporary neurological dysfunction( TND) and permanent neurological dysfunction( PND) were compared between the groups. Results Compared with group A,time of deep hypothermia and cerebral perfusion in group R was significantly longer( P <0.05),but other parameters of the two groups showed no statistical significance( P ≥0.05). Conclusion Both RCP and ACP can provide effective cerebral protection for Stanford A aortic dissection surgery,and their clinical effects are not significantly different.

关 键 词：主动脉夹层 顺行脑灌注 逆行脑灌注 脑保护 

分 类 号：R654.2[医药卫生—外科学]