股静脉至股动脉体外循环下全胸腹主动脉替换术转流经验  

Perfusion management of thoracoabdominal aortic aneurysm repair using partial femoral to femoral cardiopulmonary bypass

作　　者：杨璟[1] 邢家林[1] 王嵘[2] 刘永民[3] 朱俊明[3] 侯晓彤[1] 孙立忠[3] Yang Jing;Xing Jialin;Wang Rong;Liu Yongmin;Zhu Junming;Hou Xiaotong;Sun Lizhong(Department of Extracorporeal Circulation,Center for Cardiac Intensive Care,Capital Medical University Affiliated Beijing Anzhen Hospital,Beijing 100029,China;Department of Anesthesiology,Capital Medical University Affiliated Beijing Anzhen Hospital,Beijing 100029,China;Department of Cardiac Surgery,Center of Aortic Disease,Capital Medical University Affiliated Beijing Anzhen Hospital,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心脏外科危重症中心,体外循环与机械辅助循环科,100029 [2]首都医科大学附属北京安贞医院麻醉科,100029 [3]首都医科大学附属北京安贞医院心脏外科,100029

出　　处：《中华胸心血管外科杂志》2021年第7期418-421,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的:回顾分析全胸腹主动脉替换术中应用经股静脉至股动脉转流实施腹腔脏器灌注保护的经验。方法:2016年9月至2020年8月,50例患者接受股静脉至股动脉转流体外循环辅助下全胸腹主动脉替换。男性30例,女性20例,年龄21~69岁,平均(40.5±12.4)岁。早期25例患者单纯应用部分体外循环技术,2019年11月起开始使用体外循环联合选择性腹腔脏器灌注技术,应用球囊导管经腹腔干、肠系膜上动脉灌注温血,经肾动脉灌注4℃HTK液,25例患者接受了脏器灌注。结果:体外循环(116.9±35.4)min,转流中最低中心温度(34.7±0.7)℃。术后早期死亡3例(6%,3/50),灌注组无死亡。术后截瘫并发症4例(8%,4/50),术后新发肾功能衰竭透析治疗6例(12%,6/50),其中腹腔灌注组2例(8%,2/25),无灌注组4例(16%,4/25)。结论:经股静脉至股动脉浅低温部分体外循环结合选择性腹腔脏器灌注是有效的脊髓和腹腔脏器保护措施,可提高全胸腹主动脉替换术的安全性。Objective Analysis the protective effect of the partial femoral to femoral cardiopulmonary bypass(CPB)on thoracoabdominal aortic aneurysm repair(TAAAR).Methods From September 2016 to August 2020,50 cases of TAAAR under partial CPB were performed at our hospital.Thirty males and 20 females with an average age of(40.5±12.4)years old(ranging 21 to 69 years old)were involved.Partial CPB without selective organ perfusion were applied at the early stage.Since November 2019,the adjunct of perfuse the celiac and superior mesenteric artery with warm blood and irrigate the renal artery with 4℃ HTK solution was used in TAAAR,and 25 patients were operated under this adjunct.Results The average CPB time was(116.9±35.4)min,the lowest central body temperature during the partial CPB was(34.7±0.7)℃.Total early postoperative mortality was 6%(3/50,3 deaths in partial CPB alone group).Paraplegia occurred in 4 cases(8%),new happened postoperative hemodialysis was in 6 cases(16%).Among the hemodialysis event,2 cases(8%,2/25)were in the group with selective organ perfusion,and 4 cases(16%,4/25)in the group without using the adjunct.Conclusion Mild hypothermic partial cardiopulmonary bypass combined with selective organ perfusion have protective effects on spinal cord and abdominal organ in patients underwent TAAAR.

关 键 词：全胸腹主动脉替换术 部分体外循环 脊髓保护 器官保护 

分 类 号：R654.3[医药卫生—外科学]