体外循环心脏术后重度脑损害临床分析

Clinical study of severe cerebral damage following cardiac surgery with cardiopulmonary bypass

目的 探讨体外循环（Ｃａｒｄｉｏｐｕｌｍｏｎａｒｙ ｂｙｐａｓｓ，ＣＰＢ）心脏术后重度脑损害的原因及防治方法。方法 分析１８例ＣＰＢ术后并发重度脑损害的诊治过程及预后。结果 脑缺氧综合征１２例，硬脑膜外／下出血５例，脑实质出血１例。治愈１１例，好转１例，死亡６例。结论ＣＰＢ中提高灌注流量和应用微栓过滤器是降低脑并发症的重要措施，上腔静脉逆行灌注和高压氧的应用是治疗脑气栓的有效方法，早期诊断和及时手术清除血肿是治疗硬脑膜外／下血肿的关键。

Objective To study the cause and methods of prevention and treatment of severe cerebral damage following cardiac operation with cardiopulmonary bypass (CPB) . Methods To study the diagnosis, treatment and prognosis of severe cerebral damage during cardiac operation with CPB in 18 cases. Results There are 12 cases of cerebral hypoxemia syndrome, 5 cases of epidural hematoma and 1 case of cerebral hemorrhage. There are 11 total recovery.1 partial recovery and 6 deaths. Conclusions High perfusion volume and application of micro- emboli filter are important methods to reduce risk of cerebral complications. Rrtro-perfusion of supravena cava and applications of hyperbaric oxygen are effective methods to treat cerebral air embolism. Early diagnosis and early re- moval of hemorrhage are critical to treat epidural hematoma.