药物联合双侧顺行性脑灌注在中低体温停循环A型主动脉夹层手术脑保护中的临床研究  

Clinical practice study of drug combined with bilateral anterograde cerebral perfusion in brain protection of hypothermic circulatory arrest type A aortic dissection surgery

作　　者：李文通[1] 张明 李弯 余俊健[1] 钟钦文[1] 巫光华[1] 刘子由[1] LI Wentong;ZHANG Ming;LI Wan;YU Junjian;ZHONG Qinwen;WU Guanghua;LIU Ziyou(The First Affiliated Hospital of Gannan Medical College,Ganzhou 341000,China;Ruijin People's Hospital,Ruijin 342500,China)

机构地区：[1]赣南医学院第一附属医院,江西赣州341000 [2]瑞金市人民医院,江西瑞金342500

出　　处：《临床医药实践》2023年第5期342-344,347,共4页Proceeding of Clinical Medicine

基　　金：赣州市指导性科技计划项目(项目编号:GZ2020ZSF004)。

摘　　要：目的:探讨药物联合双侧选择性顺行脑灌注对中低体温停循环(MHCA)A型主动脉夹层(TAAD)患者的脑保护作用。方法:选择赣南医学院第一附属医院2021年1月—2022年2月收治的TAAD行孙氏手术患者90例,采用简单随机数字表法分为A组[采用单侧选择性顺行脑灌注(UASCP)]、B组[采用双侧选择性顺行脑灌注(BASCP)]及C组[药物(精氨酸+硫酸镁+丙泊酚)联合BASCP]三组,每组30例,比较三组治疗效果。结果:三组手术时间、术后ICU停留时间、术后麻醉清醒时间、术后出现短暂性神经功能缺损(TND)例数及中国临床神经功能缺损程度(CSS)评分>16分的例数比较,差异有统计学意义(P<0.05)。与A组患者相比,B组患者手术时间、体外循环时间明显减少,C组患者手术时间明显增加(P<0.05);A组术后ICU停留时间长于C组(P<0.05);A组与B组患者术后出现TND例数、CSS评分大于16分的例数均多于C组(P<0.05);A组与B组患者术后清醒时间均长于C组(P<0.05)。结论:药物联合双侧顺行选择性脑灌注(BASCP)方案可有效缩短MHCA下行孙氏手术TAAD患者的术后清醒时间,降低术后神经功能缺损的发生率。Objective:To investigate the cerebral protective effect of drugs combined with bilateral selective antegrade cerebral perfusion in patients with moderate hypothermia and circulatory arrest(MHCA)type A aortic dissection(TAAD).Methods:A total of 90 patients with type A aortic dissection who underwent Sun's surgery who were admitted to the First Affiliated Hospital of Gannan Medical College from January 2021 to February 2022 were selected and randomly divided into three groups using a simple random number table,group A[unilateral selective antegrade cerebral perfusion(UASCP)group],group B[bilateral selective antegrade cerebral perfusion(BASCP)group]and group C[drug(arginine+magnesium sulfate+propofol)combined with BASCP group],30 cases in each group,and the treatment effects of the three groups were compared.Results:There were statistically significant differences among the three groups in operation time,postoperative ICU stay time,postoperative anesthesia wake time,postoperative transient neurologic deficits(TND)cases and chinese clinical neurological deficit scale(CSS)>16(P<0.05).Compared with group A,the operation time and extracorporeal circulation time of group B were significantly reduced,while the operation time of group C was significantly increased(P<0.05).Postoperative ICU stay time in group A was longer than that in group C(P<0.05).The number of patients with transient neurological impairment after surgery in group A and group B and the number of patients with Chinese clinical neurological impairment degree score greater than 16 were higher than those in group C(P<0.05).Postoperative wakefulness time of group A and Group B was longer than that of group C(P<0.05).Conclusion:The drug combined with BASCP scheme can effectively shorten the postoperative wake-up time and reduce the incidence of postoperative neurological deficit in patients with TAAD undergoing sun's surgery under MHCA.

关 键 词：A型主动脉夹层 顺行性脑灌注 脑保护 药物 

分 类 号：R654.2[医药卫生—外科学]