不同脑保护方法对深低温停循环主动脉手术后短暂性神经功能障碍的影响

Impact of different brain protection techniques upon postoperative temporary neurological dysfunction in aortic surgery with the aid of deep hypothermic circulatory arrest

目的评价不同脑保护方法对深低温停循环(DHCA)主动脉手术后短暂性神经功能障碍(TND)的影响。方法对78例行 DHCA 主动脉手术患者的临床资料进行回顾性分析,比较逆行性脑灌注(RCP)和选择性顺行脑灌注(SCP)两种不同脑保护方法术后 TND 的发生情况,同时考察DHCA 时程对 TND 发生率的影响。结果 RCP 组 TND 的发生率为34.9%(15/43),SCP 组则为11.4%(4/35),两组间比较差异有统计学意义(P<0.05)。同时长 DHCA 时程(>50 min)的 TND 的发生率亦明显高于短 DHCA 时程(<50 min)的 TND 发生率(P<0.05)。结论采用 SCP 作为脑保护方法和缩短 DHCA 时程可以降低 TND 的发生率,能够更好的保护脑功能。

Objective To assess impact of different brain protection techniques upon postoperative temporary neurological dysfunction in aortic surgery with the aid of deep hypothermic circulatory arrest. Methods From January 2003 to December 2005, 78 patients who met the inclusion criteria entered the present cohort, 43 of whom were under the aid of deep hypothermic circulatory arrest plus retrograde cerebral perfusion （ RCP group） and the other 35 under deep hypothermic circulatory arrest plus selective antegrade cerebral perfusion （SCP group）. The present and grades of postoperative temporary neurological dysfunction were assessed by independent observers with the same criterion. The impact of duration of deep hypothermic circulatory arrest upon the postoperative temporary neurological dysfunction was also evaluated. Results The incidence of postoperative temporary neurological dysfunction was significantly higher in the RCP group than in the SCP group （ 15, 34. 9% vs. 4, 11.4%, P 〈 0. 05 ）. And long duration of deep hypothermic circulatory arrest （more than 50 min） has a negative impact on the postoperative temporary neurological dysfunction rate. Conclusions Applying selective antegrade cerebral perfusion as the brain protection technique and shortening the duration of deep hypothermie circulatory arrest can reduce the incidence of temporary neurological dysfunction and preserve cerebral function more effectively.