单中心婴幼儿主动脉弓手术选择性脑灌注结果分析  

Analysis of the Results of Aortic Arch Plasty under the Selective Antegrade Cerebral Perfusion in Pediatric Patients in Single-center

作　　者：于洋[1] 崔博群 林多茂[1] 马骏[1] YU Yang;CUI Boqun;LIN Duomao;MA Jun(Beijing Anzhen Hospital Affiliated to Capital Medical University,Beijing 100000,China)

机构地区：[1]首都医科大学附属北京安贞医院,北京市100000

出　　处：《中国分子心脏病学杂志》2023年第3期5406-5409,共4页Molecular Cardiology of China

摘　　要：目的 汇报单中心婴幼儿选择性脑灌注(SACP)策略下主动脉弓成形术结果,并对比单纯SACP与SACP联合降主动脉插管(DAC)持续下肢灌注对保护肾功能的有效性,以及不同灌注策略对婴儿主动脉弓重建术后病程的影响。方法2012年1月至2022年6月连续56例行主动脉弓成形术患儿纳入本研究。所有手术均在SACP策略下进行,依据是否采用额外下肢灌注(降主动脉插管,DAC)策略,将患儿分为单纯SACP组(n=41)与额外DAC组(n=15)。两组患儿基线资料无统计学差异。拟比较的终点事件包括两组患儿的生存率、体外循环时间、ICU时间、术后肾功能等情况。平均随访时间(4.4±2.7)年(6个月至10年)。结果 额外DAC组和单纯SACP组中分别有2例(13.3%)和5例(12.2%)患儿死亡(P=0.91)。单纯SACP组中有更多患者需要肾脏替代治疗(P=0.03),以及更高的急性肾损伤发生率(P=0.05)。相较于单纯SACP组,额外DAC组体外循环时间(P=0.02)及ICU时间均明显降低(P=0.04)。两组间神经系统并发症无统计学差异(P=0.49)。结论 婴幼儿SACP策略下行主动脉弓成形结果满意。顺行脑灌注合并通过DAC持续下肢灌注可以有效改善主动脉弓重建手术婴儿的术后早期结果。Objective To report the results of aortic arch plasty under the selective antegrade cerebral perfusion(SACP) strategy in pediatric patients in single-center and to compare the effectiveness of continuous lower limb perfusion of SACP and SACP combined with descending aorta intubation(DAC) in protecting renal function,as well as the impact of different perfusion strategies on the course of disease after aortic arch reconstruction in infants.Methods From January 2012 to June 2022,56 consecutive children underwent aortic arch plasty were chosen in our hospital.All operations were performed under the SACP strategy.The children were divided into simple SACP group(n =41) and additional DAC group(n =15) according to whether additional lower limb perfusion(descending aortic cannulation,DAC) strategy was used.There was no difference in baseline data between the two groups.The end points to be compared include survival rate,cardiopulmonary bypass time,ICU time and postoperative renal function of the two groups.The average follow-up time was 4.4 ± 2.7 years(6 months-10years).Results In additional DAC group and simple SACP group,2 patients(13.3%) and 5 patients(12.2%) died respectively(P =0.91).More patients in the simple SACP group need renal replacement therapy(P =0.03) and have a higher incidence of acute renal injury(P =0.05).Compared with simple SACP group,the cardiopulmonary bypass time(P =0.02) and ICU time in additional DAC group were significantly reduced(P=0.04).There was no significant difference in neurological complications between the two groups(P =0.49).Conclusions The results of SACP strategy for aortic arch plasty in infants are satisfactory.Antegrade cerebral perfusion combined with continuous lower limb perfusion through DAC can effectively improve the early postoperative results of infants undergoing aortic arch reconstruction.

关 键 词：婴儿 先天性心脏病 主动脉弓重建 急性肾损伤 选择性脑灌注 下肢灌注 

分 类 号：R726.5[医药卫生—儿科]