逆行脑灌注在主动脉根部和右半弓置换手术中的应用  

Application of retrograde cerebral perfusion in aortic root replacement combined with right half aortic arch replacement

作　　者：陈宇倩 胡庆华[1] 黄凌瑾[1] 陈旭良[1] 张成梁[1] CHEN Yuqian;HU Qinghua;HUANG Lingjin;CHEN Xuliang;ZHANG Chengliang(Department of Cardiovascular Surgery,Xiangya Hospital,Central South University,Changsha 410008;Graduate School,Central South University,Changsha 410017,China)

机构地区：[1]中南大学湘雅医院心脏大血管外科,长沙410008 [2]中南大学研究生院,长沙410017

出　　处：《中南大学学报（医学版）》2022年第5期650-654,共5页Journal of Central South University ：Medical Science

基　　金：湖南省自然科学基金(2019JJ50950)。

摘　　要：目的:涉及主动脉弓的心脏手术后神经系统并发症发生率较高,故术中脑保护措施非常重要。本研究旨在探讨在同期行主动脉根部和右半弓置换手术中应用深低温停循环及逆行脑灌注的安全性及有效性。方法:回顾性分析在中南大学湘雅医院行主动脉根部和右半弓置换手术且在术中采用深低温停循环及逆行脑灌注技术的患者31例,其中主动脉瘤病变23例,主动脉夹层8例。主动脉根部置换采用Bentall手术者26例,采用David手术者5例。术中停循环及逆行脑灌注时间为(21.9±5.2)min。观察并计录住院病死率、神经系统并发症以及其他不良事件。结果:未出现术后死亡及持久神经系统症状的患者,2例出现短暂谵妄,2例出现低氧血症,1例进行了二次开胸。随访时间为6~36个月,患者恢复满意。结论:在主动脉根部和右半弓置换手术中,应用深低温停循环和逆行脑灌注技术可以简化操作且安全有效,值得在临床上推广。Objective:After cardiac surgery involving the aortic arch,the incidence of neurological complications remains high,therefore it is very important to take measures to protect brain.This study is to investigate the safety and effectiveness of deep hypothermic circulatory arrest and retrograde cerebral perfusion for aortic root combined with right half aortic arch replacement.Methods:Clinical data of 31 patients,who underwent aortic root and right half aortic arch replacement with deep hypothermic circulatory arrest and retrograde cerebral perfusion in Xiangya Hospital,Central South University,were retrospectively analyzed.This cohort included 23 aortic aneurysms and 8 aortic dissections.Aortic root replacement was conducted in 26 patients by Bentall procedures,and 5 patients by David procedures.Time of deep hypothermic circulatory arrest and retrograde cerebral perfusion in surgery was(21.9±5.2)min.The in-hospital mortality,postoperative neurological dysfunction and other major adverse complications were observed and recorded.Results:No in-hospital death and permanent neurological dysfunction occurred.Two patients had transient neurological dysfunction and 2 patients with aortic dissection requiring long-time ventilation due to hypoxemia,1 patient underwent resternotomy.During 6−36 months of follow-up,all patients recovered satisfactorily.Conclusion:Deep hypothermic circulatory arrest and retrograde cerebral perfusion can be safely and effectively applied in aortic root and right half aortic arch replacement,and which can simplify the surgical procedures and be worth of clinical promotion.

关 键 词：主动脉根部置换 主动脉弓置换 深低温停循环 逆行脑灌注 

分 类 号：R654.3[医药卫生—外科学]