上腔静脉逆行灌注在胸主动脉夹层瘤手术中的应用

Retrograde Perfusion Via the Superior Vena Cava during Operation on the Thoracic Aneurysms

目的：探讨安全、实用和适合胸主动脉瘤手术操作的体外循环灌注方案。方法：在深低温停循环（DHCA）基础上，用上腔静脉逆行灌注的体外循环方法，进行了2例Bentall手术和1例弓降部主动脉移植重建，对上腔静脉逆行灌注的管道连接、灌注条件控制及逆灌过程中进出脑的血氧含量，病人瞳孔变化，术后清醒时间和恢复情况进行总结。结果：上腔静脉逆行灌注时间36～68分，逆灌期间进、出脑血氧差28．8～59．3ml／L；瞳孔直径散大至4～10mm；第1、2例病人清醒时间分别为术后4小时15分和2小时35分，无手术并发症，于术后第24天和第10天痊愈出院；第3例因术后反复心律失常和严重低心排于手术当天在ICU死亡。结论：上腔静脉逆行灌注使脑组织得到必须的动脉血供，是一种有效延长DHCA时间并适合胸主动脉瘤手术特点的体外循环灌注方法。

To investigate a safe, time-saving method of perfusion during surgery for thoracic aneurysms. Methods: Three patients of thoracic aneurysm have been operated utilizing continuous retrograde perfusion via the superior vena cave (SVC) during deep hypothermic circulatory arrest (DHCA). Two patients underwent Bentall operation;One underwent replacement of aortic arch and descending aorta. The circuit for retrograde perfusion through the SVC,the driving pressure and the blood flow, the oxygen content in the perfused blood and returned blood, pupillary respones,and duration of awaking were evaluated. Results: The retrograde perfusion duration was ranged from 36 ~ 68 minutes;The oxygen content gradient between the perfused blood and returned blood varied from 28. 8 ~ 59. 3ml/L; Platycoria with diameter 4 ~ 10mm; The first two patients awakened within 4h 15min and 2h 35min respectively , and were discharged at the 24th and 10th day after operations with no operative complication. The third patient died of intractable ventricular arrhythmia and low cardial output symdrome at first operative day in ICU. Conclusion: Retrograde perfusion via the SVC will maintain cerebral oxygenation necessarily, improve cere bral protection during DHCA. This method extends the 'safe'time for hypothermic circulatory arrest, meanwhile offers advantage for some types of thoracic aneurysm, particularly in aortic arch operation.