主动脉夹层杂交手术治疗的体外循环管理

Management of cardiopulmonary bypass in hybrid operation of aortic dissection

目的回顾性总结主动脉夹层杂交手术治疗的体外循环(CPB)管理经验。方法 2014年1月至2015年12月,18例主动脉夹层患者行杂交手术。采用浅低温、常规流量CPB,根据手术需要予以短暂停循环,同时行选择性脑及右上肢区域灌注。撤离CPB后同期行主动脉腔内修复术(TEVAR)。结果 CPB时间、主动脉阻断时间及停循环时间分别为76~253(152.88±47.29)min、32~146(84.22±33.16)min、0~7(1.50±2.25)min,最低鼻咽温30~32℃。术后1例(5.5%)死于心肌梗死,其余17例均痊愈出院。结论在浅低温CPB下进行主动脉夹层手术安全可靠。体外循环医生与术者、麻醉医生紧密协作有助于围术期患者安全。

Objective To review the experience of cardiopulmonary bypass （CPB） management in the hybrid procedures of aortic dissection.Methods From January 2014 to December 2015,18 patients with aortic dissection underwent hybrid operation.Mild hypothermia and conventional flow CPB were performed.According to the operation requirments,a transient CPB stop might be used,at the same time selective brain and right upper limb regional perfusion were applied.After weaning from CPB,thoracic endovascular aortic repair （TEVAR） began.Results CPB time,aortic crossclamp time and circulatory arrest time were 76-253 （152.88 ± 47.29）mins,32-146 （84.22±33.16） mins and 0-7 （1.50±2.25） mins,repectively.The lowest nasopharyngeal temperature was 30℃-32℃.Postoperatively 1 case （5.5%） died of myocardial infarction,the other 17 cases were cured.Conclusion Mild hypothermia CPB is safe and reliable for aortic dissection surgery.It is helpful to the safety of perioperative patients with cooperation by perfusionists,surgeons and anesthetists.