不同脑灌注方式在老年急性主动脉夹层中的脑保护作用比较及机制  

Comparison of cerebral protective effect and mechanism of different cerebral perfusion methods in elderly acute aortic dissection

作　　者：朱涛[1] 张为民[1] 阿不都乃比·麦麦提艾力 刘正[1] 俞国军[1] 霍强[1] Zhu Tao;Zhang Weimin;Abudunaibi·Maimaiti Aili;Liu Zheng;Yu Guojun;Huo Qiang(Department of Cardiology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054)

机构地区：[1]新疆医科大学第一附属医院心脏外科,乌鲁木齐830054

出　　处：《国际老年医学杂志》2025年第2期134-140,共7页International Journal of Geriatrics

基　　金：国家自然科学基金(82060907)。

摘　　要：目的探讨不同脑灌注方式在老年急性主动脉夹层中脑保护作用及其机制。方法(1)选择2015年1月-2023年1月新疆医科大学第一附属医院心脏外科同一手术组收治的206例老年急性Stanford A型主动脉夹层同期弓部手术病例作为研究对象。根据颈内动脉狭窄程度分为A(狭窄度<50%,68例)、B(狭窄度为50%~70%,68例)、C(狭窄度>70%,70例)三组,B组和C组再分为B1(34例)、B2(34例)、C1(35例)、C2(35例)四个亚组。A组和B1组均采用单纯深低温停循环下右腋动脉选择性脑灌注,灌注量为5~10 mL/(kg·min);B2组和C1组仍采用上述灌注方法,灌注量为10~15 mL/(kg·min);C2组采用双侧灌注,灌注量10~15 mL/(kg·min)。采用脑干听觉诱发电位(BAEP)、韦氏记忆量表、Glasgow昏迷评分检测术前术后神经功能。(2)实验动物选用白猪幼猪48只,雌雄不限,体质量8~10 kg。使用血管夹或缝线技术造成不同程度的狭窄,再根据灌注方法分为A(16只)、B1(8只)、B2(8只)、C1(8只)、C2(8只)五组。动物实验中各组的灌注方式和各组的灌注量同方法(1)。各组动物血液B细胞淋巴瘤因子-2(Bcl-2)、Bcl-2相关X蛋白(Bax)含量进行蛋白质免疫印迹检测。结果(1)术前1天,各组间的BAEP比较差异均无统计学意义(P>0.05);术后第1天,各组间的BAEP比较差异均有统计学意义(P<0.05),且B1组BAEP大于A组(P<0.05),B2组BAEP小于B1组(P<0.05),C1组大于B2组(P<0.05),C2组BAEP小于C1组(P<0.05)。术前1天与术后第7天,各组间的韦氏记忆量表结果差异无统计学意义(P>0.05),但术后第7天,B1组、B2组、C1组、C2组的韦氏记忆量表结果均低于术前1天(P<0.05)。术前1天及术后第1天,各组的Glasgow昏迷评分组间比较,差异均无统计学意义(P>0.05)。术后第1天,B1组、B2组、C1组、C2组Glasgow昏迷评分均低于术前1天,差异均有统计学意义(P<0.05)。B1组出现1例昏迷,术后第7天恢复;C1组出现1例定向力障碍,术后第5天恢复;其余各组�Objective To investigate the cerebral protection effect of different cerebral perfusion methods in elderly patients with acute aortic dissection and its mechanism.Methods(1)A total of 206 elderly cases of acute type Stanford A aortic dissection admitted to the same surgery group in the cardiac surgery department of the First Affiliated Hospital of Xinjiang Medical University from January 2015 to January 2023 were selected as the study subjects.According to the degree of internal carotid artery stenosis,it was divided into three groups:A(stenosis<50%,68 cases),B(stenosis from 50%-70%,68 cases)and C(stenosis>70%,70 cases).Group B and C were divided into four subgroups:B1(34 cases),B2(34 cases),C1(35 cases)and C2(35 cases).In group A and group B1,selective cerebral perfusion was 5-10 mL/(kg·min);in group B2 and group C1,selective cerebral perfusion was 10-15 mL/(kg·min);in group C2,bilateral perfusion was 10-15 mL/(kg·min).Brainstem auditory evoked potential(BAEP),Wechsler memory scale and Glasgow coma score were used to detect preoperative and postoperative neurological function.(2)Experimental animals selected 48 white pigs,male and female,weight 8-10 kg.Blood vessel clip or suture technology were used to cause different degrees of stenosis.According to the infusion method,they were divided into five groups:A(16 mice),B1(8 mice),B2(8 mice),C1(8 mice)and C2(8 mice).In animal experiments,the perfusion method and volume of each group were the same as in study(1).Protein immunoblotting was performed to detect the levels of B-cell lymphoma 2(Bcl-2)and Bcl-2 related X protein(Bax)in the blood of each group of animals.Results(1)One day before surgery,there was no significant difference in BAEP between the groups(P>0.05);on the first day after surgery,there were significant differences in BAEP between the groups(P<0.05),and BAEP in group B1 was greater than that in group A(P<0.05),BAEP in group B2 was less than that in group B1(P<0.05),group C1 was greater than that in group B2(P<0.05),and BAEP in group C2 was less tha

关 键 词：脑灌注方式 急性主动脉夹层 脑保护作用 神经并发症 

分 类 号：R74[医药卫生—神经病学与精神病学]