顺行与逆行性脑灌注对主动脉弓置换术患者脑保护的比较  

Comparation of cerebral protection in patients treated with aortic arch replacement under antegrade and retrograde cerebral perfusion

作　　者：李欣[1] 杨珏[1] 于长江[1] 孙图成[1] 范小平[1] 范瑞新[1] LI Xin;YANG Jue;YU Chang-jiang;SUN Tu-cheng;FAN Xiao-ping;FAN Rui-xin(Department of Cardiac Pediatrics,Guangdong Cardiovascular Institute,Guangdong Provincial People′s Hospi⁃tal,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]广东省心血管病研究所心外科广东省人民医院(广东省医学科学院)

出　　处：《岭南心血管病杂志》2019年第6期665-671,共7页South China Journal of Cardiovascular Diseases

基　　金：国家重点研发计划课题（项目编号：2017YFC1308003）;广东省医学科学技术研究基金（项目编号：A2016416）

摘　　要：目的比较主动脉夹层患者在主动脉弓部置换术中使用两种脑灌注方式下脑保护的效果,优化主动脉弓部手术脑保护策略。方法回顾性分析2017年9月至2018年12月在广东省人民医院行顺行性脑灌注(37例)和逆行性脑灌注(24例)主动脉弓部替换手术患者的临床资料,结合脑氧饱和度监测和脑损伤标记物检测,比较两组患者资料的差异。结果主动脉弓部置换术后患者顺灌组和逆灌组发生暂时性神经功能障碍分别为7、1例,永久性脑损伤各1例,两组死亡分别为2、3例。顺行性脑灌注组和逆行性脑灌注组患者除近红外线光谱脑氧饱和度监测数据,其他观测指标比较,均无统计学意义(P>0.05)。结论顺行性脑灌注与逆行性脑灌注在深低温停循环主动脉弓置换术患者中对脑保护具有相近的效果。Objectives To compare the effects of brain protection under two perfusion methods in patients with aortic dissection treated by aortic arch replacement,and to optimize the brain protection strategy for aortic arch surgery.Methods Clinical data of 37 patients with antegrade cerebral perfusion and 24 patients with retrograde cerebral perfusion who underwent aortic arch replacement were collected from September 2017 to December 2018 in Guangdong Provincial People′s Hospital.Differences between the two groups were compared by combining cerebral oxygen saturation monitor and brain injury biomarker.Results There were 7 and 1 cases of temporary neurological dysfunction,1 case of permanent brain injury respectively,2 and 3 cases of death in patients treated by aortic arch replacement under antegrade or retrograde cerebral perfusion.Except for date of cerebral oxygen saturation monitored by near-infrared spectroscopy,there were no significant differences in other clinical data between antegrade cerebral perfusion group and retrograde cerebral perfusion group(P>0.05).Conclusions Retrograde cerebral perfusion and antegrade cerebral perfusion have similar effects on brain protection of patients during deep hypothermic circulatory in aortic arch replacement.

关 键 词：主动脉弓部置换 脑保护 灌注方式 脑损伤标记物 近红外线光谱 脑氧饱和度 

分 类 号：R543.1[医药卫生—心血管疾病]