主动脉弓部手术中的脑保护方法

Cerebral protection methods in aortic arch surgery

目的报告累及主动脉弓动脉瘤手术中脑保护的方法。方法 105例累及弓部动脉瘤体外循环中,99例采用深低温停循环顺行性脑灌注,2例深低温停循环上腔静脉逆行脑灌注,4例单纯深低温停循环。结果 105例深低温停循环病例中,短暂性脑损伤11例,永久性脑损伤3例,吻合口岀血6例,肺部渗漏1例,肾功能不全1例,低心排2例,感染3例,死亡11例。结论累及主动脉弓部动脉瘤手术脑保护时,选择适当的脑保护方法,减少因缺血造成的神经系统损伤是体外循环管理的关键所在。

OBJECTIVE To report cerebral protection methods in involving the aortic arch aneurysm surgery. METHODS Of 105 cases of extracorporeal circulation（ECC） in surgery for aneurysms involving the aortic arch,99 were treated with deep hypothermic circulatory arrest（DHCA） with antegrade cerebral perfusion,2 with DHCA with retrograde cerebral perfusion via superior vena cava,4 with DHCA without cerebral perfusion.RESULTS Of 105 cases of DHCA,11 patients had temporary neurologic dysfunction hypoxic,3 patients had permanent central neurologic dysfunction cerebral,6 patients had surgical bleeding,1 patient had pulmonary leakage,1 patient suffered renal dysfunction,and two patients had low cardiac output,3 patients had infection and 11 patients died.CONCLUSION To use the appropriate method of cerebral protection and minimize the cerebral injury caused by ischemia are the key to a successful ECC management in involving the aortic arch aneurysm surgery.