选择性脑灌注在儿童大血管手术中的应用

Application of Selective Cerebral Perfusion in Pediatric Great Artery Operation

目的总结选择性脑灌注(SCP)在儿童主动脉手术中的临床应用体会,探讨灌注方法。方法上海儿童医学中心在小儿主动脉手术中应用SCP技术32例,在肛温18℃～20℃时,通过无名动脉开口处进行选择性顺行脑灌。结果SCP时间为17～121(39.6±19.4)min,流量维持在15～40(29.7±6.1)ml/(kg.min)。全组死亡4例,死亡原因与神经系统无关。其余28例均存活,无神经系统并发症。结论儿童主动脉手术时,采用深低温停循环并进行SCP可以安全的延长停循环的时间,并提高脑保护的效果。

OBJECTIVE To report primary application of selective cerebral perfusion （SCP） technique in pediatric great artery operation. METHODS 32 children underwent aortic arch reconstruction with SCP in Shanghai Children Medical＇s Center. After rectal temperature decreased to about 18℃ - 20℃, the cannula was inserted into the innominate artery. The aortic arch was then reconstructed, while maintaining continuous antegrade regional cerebral perfusion through the innominate artery. RESULTS The SCP time was from 17 to 121 （39.6 ± 19.4 ） min, perfusion blood flow rate was between 15 to 40 （29.7 ±6.1 ）mE/ （kg · min）. 4 cases died of non -neurologie causes and the other 28 cases survived without neurologica complications. CONCLUSION Selective cerebral perfusion is a simple, feasible, safe and effective technique in pediatric aortic arch reconstruction procedure.