深低温停循环选择性脑灌注在主动脉夹层手术中的应用

Application of deep hypothermic circulatory arrest and selective cerebral perfusion in the surgical treatment of aortic dissection

目的总结经右腋动脉插管体外循环（ECC）、右腋动脉插管选择性顺行脑灌注（ASCP）在主动脉夹层手术中应用的初步经验。方法该院2008年5月~2012年5月手术治疗I型主动脉夹层动脉瘤9例,均采用深低温停循环（DHCA）加右腋动脉插管选择性顺行脑灌注（ASCP）方法。升主动脉＋全弓置换＋象鼻支架术4例,升主动脉＋右半弓置换术2例,BentaLL＋全弓置换＋象鼻支架术3例。心肌保护均采用4︰1含血冷停搏液。结果全组ECC时间127~396 min,平均（180±46）min,主动脉阻断时间69~258 min,平均（129±42）min,DHCA时间12~50 min,平均（28±13）min,ASCP时间12~56 min,平均（30±14）min。无手术死亡,术后一过性意识障碍1例,均治愈出院,无永久性脑损害发生。结论在主动脉夹层手术中采用深低温停循环右腋动脉插管选择性顺行脑灌注可提供有效的脑保护,其操作简便、安全,减少并发症,提高手术的成功率。

【Objective】 To summarize the perfusion experience in aortic dissection using antegrade selective cerebral perfusion（ASCP） with right axillary artery perfusion of extracorporeal circulation（ECC）.【Methods】 From May 2008 to May 2012,9 patients in aortic dissection with deep hypothermic circulatory arrest（DHCA） underwent surgery with right axillary artery perfusion for cerebral protection and ASCP.Surgical procedures included ascending aorta and total arch replacement with elephant trunk technique in 4 cases,ascending aorta and semi arch replacement in 2 cases,and Bentall procedure and total arch replacement with elephant trunk technique in 3 cases.Myocardial protection was established with cold blood cardioplegia.【Results】 The ECC time was 127 ~ 396（180 ± 46） min,aortic clamp time was 69 ~ 258（129 ± 42） min,DHCA time was 12 ~ 50（28 ± 13） min,selective cerebral perfusion time was 12 ~ 56（30 ± 14） min.There was no postoperative death and all patients were well-cured and discharged from hospital.【Conclusions】 The use of selective cerebral perfusion through right axillary arter cannulation in aortic dissection surgery can get effective brain protection and reduce the postoperative nervous system complications with acceptable results and ensure successful operation.