主动脉弓部手术中顺行脑灌注的流量管理对患者中枢神经系统并发症的影响

The effect of flow management of cerebral perfusion during aortic arch surgery on the neurological complication

目的探讨A型急性主动脉夹层弓部手术中顺行脑灌注的不同流量管理方法对患者术后中枢神经系统并发症的影响。方法对我科2007年3月至2011年11月189例A型急性主动脉夹层患者弓部手术的临床资料进行回顾性分析，根据顺行性脑灌注流量的不同管理方法分为A、B两组。A组96例采用单泵双管进行下半身和脑部同时灌注，灌注流量自然分配；B组93例在连接脑灌注的动脉供血管上加装一个离心泵电磁流量传感器探头，精确监控脑灌注的流量（10ml·kg-1·min。-1）。比较两组患者术后中枢神经系统并发症发生率。结果两组体外循环时间、升主动脉阻断时间及停循环时间的组间差异无统计学意义（P〉0．05）。A组术后中枢神经系统并发症发生率5．2％，B组1．1％，B组明显低于A组，差异有统计学意义（P〈0．05）。结论主动脉弓部手j长行顺行性脑灌注时，精确控制其流量能有效降低术后中枢神经系统并发症。

Objective To investigate the effect of flow management of cerebral perfusion during aortic arch surgery on the neurological complication. Methods From March 2007 to November 2011, 189 patients underwent aortic arch surgery with hypothermic circulatory arrest plus antegrade cerebral perfuslon in our department. The clinical data were analyzed retro- spectiyely. According to the different methods of cerebral perfusion flow management, patients were divided into two groups. SingleI pump with double limb （ to the lower body and brain） perfusion was used in group A （ 96 patients）, based on natural distribution of perfusion flow without control. Modified flow management was used in group B （93 patients）. A magnetic flow sensor probes was installed on the brain perfusion limb to monitor and control the cerebral perfusion flow precisely （10 ml ~ kg- 1 . min-l）. Postoperative neurological complications were compared between two groups. Results There was no significant difference between the two groups in CPB time, aortic clamping time and circulatory arresting time. However, the morbidity of postoperative neurological complications in group B was much lower than that in group A （ 1.1% vs 5.2%, P 〈 0. 05 ）. Conclusion When performing antegrade cerebral perfusion during aortic arch surgery, precisely control of cerebral perfusion flow can reduce the morbidity of postoperative neurological complications effectively.