低温停循环选择性脑灌注应用于胸主动脉瘤的手术治疗  

Surgical treatment of thoracic aortic aneurysm with hypothermic circulatory arrest and antegrade selective cerebral perfusion

作　　者：卢成宝[1] 萧明第[1] 薛松[1] 袁忠祥[1] 吕志前[1] 叶一舟[1] 王利民[1] 刘沙[1] 

机构地区：[1]上海市第一人民医院心外科,上海200080

出　　处：《临床心血管病杂志》2003年第3期155-157,共3页Journal of Clinical Cardiology

摘　　要：目的 :总结右锁骨下动脉插管、中度低温停循环 (HCA)、顺行选择性脑灌注 (ASCP)行胸主动脉瘤手术治疗的经验。方法 :11例患者中 ,男 10例 ,女 1例 ,夹层动脉瘤 10例 (慢性DeBakeyI型 5例 ,Ⅱ型 4例 ,急性Ⅱ加Ⅲ型 1例 ) ,升主动脉瘤加降主动脉缩窄 1例 ,均并发主动脉瓣中重度反流。术中采用右锁骨下动脉 右房插管 ,建立体外循环后并行降温至 30℃ ,阻断升主动脉 ,处理近端并继续降温至 2 3℃ ,阻断无名动脉 ,转为HCA加ASCP处理远端。 10例行Bentall术 ,1例行Bentall加升主动脉 降主动脉搭桥术。平均体外循环时间 (112 .3±37.9)min ,HCA加ASCP时间 (2 5 .4± 8.8)min。结果 :所有患者均于术后 4～ 6h清醒 ,无死亡及脑部并发症。结论 :以右锁骨下动脉插管建立体外循环、HCA加ASCP ,操作简便易行 ,可安全地延长停循环时限及有效防止脑部并发症 。Objective:We review our clinical experience of surgical treatment of thoracic aortic aneurysm using right subclavian artery cannulation, moderate hypothermic circulatory arrest and antegrade selective cerebral perfusion.Methods:A total of 11 consecutive thoracic aortic aneurysm patients (mean age 51 years, range 22 to 65 years) concomitant moderate to severe aortic valvular regurgitation were studied. One of them was ascending aortic aneurysm with coarctation of descending aorta; and the other 10 cases were aortic dissections (chronic De Bakey type I 5 cases, type II 4 cases and acute type II+III 1 case). Extracorporeal circulation was established with right subclavian artery and right atrium cannulation. After the patient was cooled down to 30℃ with partial bypass, ascending aorta was cross clamped and the proximal part of the composite valve graft was sewn to aortic annulus with a continuous suture. When the body temperature was lowered to 23℃, innominate artery and left common carotid artery were clamped. While systemic circulatory was arrest, the antegrade selective cerebral perfusion was started at rate of 10 ml·min -1 ·kg -1 and the appropriate procedure was performed on distal ascending aorta. Eight patients received Bentall procedure while one underwent Bentall procedure and ascending aorta to descending aorta bypass. Mean extracorporeal circulation time was ( 112.3 ± 37.9 ) min and mean antegrade selective cerebral perfusion time was ( 25.4 ± 8.8 )min.Results:All patients recovered from anesthesia between 4 to 6 hours after operation. There were no death and no cerebral morbidity.Conclusion:Right subclavian artery cannulation with hypothermic circulatory arrest and antegrade selective cerebral perfusion allows increased ease of surgical performance and prolonged safe time limit of circulatory arrest and helps reduce cerebral morbidity, may lead to improved outcomes.

关 键 词：胸主动脉瘤 低温停循环 顺行选择性脑灌注 血管外科手术 治疗 

分 类 号：R732.210.5[医药卫生—肿瘤]