单侧与双侧顺行性脑灌注在主动脉弓替换术中的效果对比

Clinical observation of unilateral and bilateral antegrade cerebral perfusion in aortic arch replacement

目的观察选择性单侧脑灌注与双侧脑灌注对行主动脉弓部替换手术的主动脉夹层患者术后病死率及神经功能障碍发生率的影响。方法选取2014-10—2018-02在郑州市第七人民医院治疗的Stanford A型急性主动脉夹层患者80例,根据夹层累及范围,在深低温停循环下行单侧或双侧顺行性脑灌注主动脉弓替换术,其中单侧脑灌注组(单侧组)43例,双侧脑灌注组(双侧组)37例。结果双侧顺行性脑灌注在术后脑损伤方面优于单侧顺行性脑灌注。2组手术时间、主动脉阻断时间、停循环时间、体外循环时间差异均无统计学意义。双侧组术后呼吸机辅助时间、ICU住院时间显著缩短(P<0.05),术后清醒时间、暂时性脑功能障碍发生率明显减少(P<0.05)。结论深低温停循环下主动脉弓替换术中无论用单侧或双侧顺行性脑灌注保护均能取得良好的效果,双侧脑灌注较单侧脑灌注的神经功能障碍发生率明显减少。

Objective To observe the effect of selective unilateral cerebral perfusion and bilateral cerebral perfusion on the rate of postoperative mortality and neurological dysfunction in aortic dissection patients undergoing aortic arch replacement surgery. Methods Eighty patients with Stanford type A acute aortic dissection treated at the Department of Cardiology,Seventh People＇s Hospital of Zhengzhou from October 2014 to February 2018,were unilaterally or bilaterally singed in deep hypothermic circulatory arrest.Aortic arch replacement was performed by cerebral perfusion.Patients were divided into two groups according to unilateral or bilateral cerebral perfusion.There were 43 cases of unilateral cerebral perfusion and 37 cases of bilateral cerebral perfusion. Results The results of this study showed that bilateral antegrade cerebral perfusion was superior to unilateral antegrade cerebral perfusion in postoperative brain injury.There were no statistical differences on operating time,aortic occlusion time,stopping time,and extracorporeal circulation time.The time of ventilator assisted and ICU stay in the bilateral cerebral perfusion group was significantly shorter （ P 〈0.05）,recovering time and the incidence of postoperative transient brain dysfunction were significantly reduced （ P 〈0.05）. Conclusion Deep hypothermic circulatory arrest can achieve good results in unilateral or bilateral antegrade cerebral perfusion brain protection during aortic arch replacement.Bilateral cerebral perfusion has a significantly lower incidence of neurological dysfunction than unilateral cerebral perfusion,which is worthy of clinical promotion.