中低温停循环和单侧顺行脑灌注在主动脉弓部置换中的应用  

Moderate hypothermic circulatory arrest and unilateral anterograde cerebral perfusion for aortic arch replacement

作　　者：唐卓[1] 张永 杨忠路 石云 刘宇 TANG Zhuo;ZHANG Yong;YANG Zhong-lu;SHI Yun;LIU Yu(Graduate School of China Medical Universiy,Shenyang 110122,China;Department of Cardiovascular Surgery,General Hospital of Northen Theater Command,Shenyang 110016,China)

机构地区：[1]中国医科大学研究生院,辽宁省沈阳市110122 [2]中国人民解放军北部战区总医院心血管外科

出　　处：《中国心血管病研究》2020年第9期819-822,共4页Chinese Journal of Cardiovascular Research

基　　金：全军医学科技青年培育计划(16QNP056);辽宁省医学科技转化专项(2018225123)

摘　　要：目的探讨中度低温停循环(MHCA)结合单侧脑灌注(SACP)在主动脉弓部置换手术中应用的安全性和有效性.方法回顾性分析我科2014年12月至2016年6月收治的91例主动脉全弓置换术患者的临床资料,其中DHCA组22例,MHCA组69例.所有患者术中皆行象鼻支架置入术,同期应用SACP.记录术后院内短暂性神经症状(TND)、持久性神经症状(PND)、死亡和肾衰竭等事件.结果两组患者术前基本资料比较差异无统计学意义,同期行主动脉瓣、冠状动脉手术组间无差异;两组平均停循环温度为[(18.9±0.9)℃比(24.0±2.6)℃,P<0.01];主动脉阻断时间、停循环时间和呼吸机辅助通气时间未见明显差异;术后病死率组间无差异(9.1%比8.7%,P=0.83).结论对于主动脉全弓置换手术,MHCA联合单侧SACP为一种安全有效的停循环策略.Objective To evaluate the safety and efciveness on moderate bypothermic circulatory arest(MHCA)combined with selective antegrade cerebral perfusion(SACP)in aortic replacement surgery.Methods The data of 91 patients undergone total aortic arch replacement in our department from December 2014 to June 2016 were retrospectively analyzed,including 22 patients in deep hypothermic circulatory arrest(DHCA)+SCAP group and 69 patients in MHCA+SCAP group;all the patients were treated with elephant trunk stent implantation.Permanent neurological dysfunction(PND),temporary neurological dysfunction(TND),death,renal failure and other events were recorded.Results There was no statistical difference in the preoperative basic data between two groups and there was no difference in the rate of aortic valve operation or coronary operation.The average cireulatory arrest temperature was[(18.9±0.9)C vs.(24.0±2.6)C,P<0.01].There was no significant difference in the aortic cross-clamp,circulatory arrest time and ventilatorassisted ventilation time between the two groups.There was no difference in the mortality between the two groups(9.1%vs.8.7%,P=0.83).Conclusion MHCA combined with unilateral SACP is a safe and ffective strategy for total aortic arch replacement.

关 键 词：中度低温 停循环 主动脉弓置换 单侧顺行脑灌注 

分 类 号：R654.2[医药卫生—外科学]