不同脑灌注方式对Stanford A型主动脉夹层患者的脑保护作用  

Cerebral protective effects of anterograde cerebral perfusion via right axillary artery and retrograde cerebral perfusion via superior vena cava in patients with Stanford type A aortic dissection

作　　者：田振宇[1] 李聪 李豪威 TIAN Zhen-yu;LI Cong;LI Hao-wei(Department of Cardiovascular Surgery,Henan Chest Hospital,Zhengzhou,Henan 450000,China)

机构地区：[1]河南省胸科医院心血管外科,河南郑州450000

出　　处：《中华全科医学》2021年第5期727-730,共4页Chinese Journal of General Practice

基　　金：河南省科技攻关计划项目(182102310137)。

摘　　要：目的探究经右侧腋动脉顺行脑灌注(ACP)和经上腔静脉逆行脑灌注(RCP)对Stanford A型主动脉夹层患者的脑保护作用。方法回顾性分析2018年1月-2019年1月在河南省胸科医院行急性Stanford A型主动脉夹层手术的76例患者的病例资料,按脑灌注方式分为2组,A组(46例)行经右侧腋动脉ACP,B组(30例)行经上腔静脉RCP。比较2组患者性别、年龄、疾病史、吸烟史、手术方式、围手术期临床资料,脑部主要并发症短暂性神经系统功能障碍(TND)、永久性神经系统功能障碍(PND)发生情况以及住院死亡情况。结果 A组患者停循环时间、脑灌注时间分别为(16.18±3.28)min、(20.77±2.82)min,明显低于B组的(24.82±3.53)min、(24.86±3.19)min,差异有统计学意义(t=10.892、5.867,均P<0.05)。A组TND发生率为17.39%,明显低于B组的43.33%,差异有统计学意义(P<0.05),而A组PND发生率和住院病死率分别为4.35%、2.17%,与B组的3.33%、3.33%比较,差异无统计学意义(均P>0.05)。结论经右侧腋动脉ACP体外循环时间、脑灌注时间较经上腔静脉RCP短,且可显著降低TND发生率,脑保护作用较好。Objective To explore the protective effects of Antegrade cerebral perfusion(ACP)via right axillary artery and Retrograde cerebral perfusion(RCP)via superior vena cava on Stanford type A aortic dissection.Methods The data of 76 patients with Stanford type A acute aortic dissection from January 2018 to January 2019 in Henan Chest Hospital were ana-lysed retrospectively.According to the way of cerebral perfusion,they were divided into two groups:group A(46 cases)received ACP via right axillary artery and group B(30 cases)received RCP via superior vena cava.The sex,age,disease history,smoking history,operation mode,perioperative clinical data,the occurrence of transient transient nervous system dysfunction(TND),permanent nervous system dysfunction(PND)and death in hospital were compared between the two groups.Results The circulatory arrest time and cerebral perfusion time in group A were(16.18±3.28)min and(20.77±2.82)min,respectively,which were significantly lower than those in group B which were(24.82±3.53)min and(24.86±3.19)min.The differences were statistically significant(t=10.892,5.867,all P<0.05).The incidence of TND in group A was 17.39%,which was significantly lower than that in group B(43.33%,P<0.05),whereas the incidence of PND and hospital mortality in group A were 4.35%and 3.33%,respectively,and there was no significant difference compared with those in group B(3.33%and 3.33%,all P>0.05).Conclusion The time of cardiopulmonary bypass and cerebral perfusion of ACP via right axillary artery was shorter than that of RCP via superior vena cava.The for-mer could significantly reduce the incidence of TND with better brain protection.

关 键 词：经右侧腋动脉顺行脑灌注 经上腔静脉逆行脑灌注 Stanford A型主动脉夹层 脑保护 

分 类 号：R654.2[医药卫生—外科学]