深度低温与中度低温在主动脉手术中的应用  

Application of deep hypothermia and moderate hypothermia in aortic arch surgery

作　　者：易秋月 杨阳 周和平 黎明[1] 郝军军[1] 任沪平 许锁春[1] YI Qiu-yue;YANG Yang;ZHOU He-ping;LI Ming;HAO Jun-jun;REN Hu-ping;XU Suo-chun(Department of Cardiovascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China)

机构地区：[1]西安交通大学第一附属医院心血管外科,陕西省西安市710061

出　　处：《中国心血管病研究》2019年第9期822-825,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨中低温选择性脑灌注的安全性及优越性。方法我院2014年1月至2017年12月升主动脉和主动脉弓手术患者154例,男性110例,女性44例,根据脑保护方法的不同分为:深低温停循环组、深低温选择性脑灌注组、中低温选择性脑灌注组。术前各临床资料比较未见统计学差异。统计分析各组病例住院期间临床疗效的差异。结果各组病例住院病死率、一过性和永久性神经系统并发症的发生率未见统计学差异(P均>0.05)。中低温选择性脑灌注组体外循环时间(184.56±24.01)min低于其他两组[深低温停循环组(216.94±25.22)min,深低温选择性脑灌注组(200.09±23.80)min,P<0.05],再次开胸率降低(P=0.029)。术后呼吸功能不全、肾衰竭、感染、腹部并发症和截瘫的发生率各组相似(P>0.05)。结论中低温选择性脑灌注是一种安全有效的脑保护方法,住院病死率和并发症发生率低,缩短了体外循环时间,降低了术后再次开胸率。Objective To investigate the safety and superiority of antegrade selective cerebral perflision in ascending aortic artery and aortic arch surgery. Methods From January 2014 to December 2017, a total of 154 patients (110 males, 44 females) underwent repair of the ascending aortic and/or aortic arch in the First Affiliated Hospital of Xi'an Jiaotong University were divided into three groups according to the m ethod of cerebral protection: deep hypothermic circulatory arrest group, deep hypothermic and antegrade selective cerebral perfusion group and moderate hypothermic and antegrade selective cerebral perfusion group. The results of the three patient groups were retrospectively compared. Results There were no significant differences in hospital mortality, transient and permanent neurological dysfunction a m o n g all the groups (all P 〉0.05). Mean duration of CPB was (184.56±24.01) m i n in moderate hypothermic antegrade selective cerebral perfusion group and significantly shorter than (216.94±25.22) m i n of deep hypothermic circulatory arrest group and (200.09±23.80) min of deep hypothermic antegrade selective cerebral perfusion group (P<0.05). There was a significant reduction in the percent of reexploration for bleeding in moderate hypothermic antegrade selective cerebral perfusion group (P=0.029). The occurrence of postoperative respiratory dysfunction, renal failure, infection, paraplegia and visceral complications were similar in every group (all P>0.05). Conclusion Moderate hypothermic and antegrade selective cerebral perfusion is an effective and safe cerebral protection method in aortic artery surgery with lower hospital mortality and complication rates. This method also reduces the duration of extracorporeal circulation and the rate of reexploration for bleeding.

关 键 词：主动脉弓 中度低温 选择性脑灌注 

分 类 号：R654.2[医药卫生—外科学]