深、中度低温停循环顺行性脑灌注技术在成人主动脉夹层手术中的应用及比较

Application and comparison of moderate and deep hypothermic circulatory arrest during adult aortic arch surgery

目的比较深、中度低温顺行性脑灌注、在成人主动脉弓部手术中的应用，探讨主动脉弓部手术的最佳脑灌注温度。方法行主动脉弓部手术患者109例，根据术中采用的脑灌注温度分为深、中度低温两组，分别记录两组患者一般情况、体外循环转流、主动脉阻断、脑灌注以及术后清醒时间、气管插管时间，重症监护室（ICU）住院时间及术后出现认知功能障碍等情况。结果两组患者均痊愈出院。主动脉阻断深低温组（111．4±58．4）min、中低温组（115．9±16．2）min；选择性脑灌注深低温组（27．4±5．9）min、中低温组（23．5±6．1）min，差异无统计学意义。两组体外循环转流深低温组（263．8±22．6）min、中低温组（207．4±20．9）min；术后清醒时间深低温组（36．8±25．3）h、中低温组（19．0±11．1）h；气管插管时间深低温组（64．4±6．0）h、中低温组（46．4±15．1）h；重症监护室住院时间深低温组（8．0±2．3）天、中低温组（4．7±1．7）天；术后出现认知功能障碍深低温组14例，中低温组10例；差异均有统计学意义。结论与深度低温相比，中度低温停循环顺行性脑灌注技术可以提供良好的脑保护作用，取得良好的临床效果。

Objective To compare the effects of moderate and deep hypothermic circulatory arrest（DHCA） during aortic arch surgery in the adult patients, to offer the evidence for the detection of which temperature provides best brain protection in the subjects who accept the great aortic surgery. Methods A total of 109 patients undergoing the surgery of aortic arch were divided into the moderate hypothermic circulatory arrest group and deep hypothermic circulatory arrest group. We recorded the characters of the patients and their cardiopulmonary bypass time, aortic clamping time, cerebral perfusion time and postopera- tive recovery time, tracheal intubation time, time of intensive care unit（ICU） and postoperative cognitive dysfunction. Results Patients＇ characteristics were similar in two groups. All the patients were cured. There were no significant differences in aor- tic clamping time of each group[ （111.4 ±58.4） min vs. （115.9 ± 16.2） mini ; selective cerebral perfusion time[ （27.4± 5.9） min vs. （23.5 ± 6.1 ） mini of the moderate hypothermic circulatory arrest group and deep hypothermic circulatory arrest group. There were significant differences in the cardiopulmonary bypass time[ （207.4 ±20.9） rain vs. （263.8 ±22.6） min] , the postoperative recovery time [ （ 19.0 ± 11.1 ） h vs. （ 36.8 ± 25.3 ） h ] , intubation time [ （46.4 ± 15.1 ） h vs. （64.4 ± 6.0 ） h ] ; length of ICU [ （4.7 ± 1.7 ） d vs. （ 8. ± 2.3 ） d ] , and postoperative cognitive dysfunction of the two groups. Conclusion Compared to the deep bypothermic circulatory arrest, the moderate hypothermic circulatory arrest can provide better brain protection and achieve good clinical results.