全主动脉弓置换手术灌注进展

Advances of perfusion in total aortic arch replacement surgery

全主动脉弓置换术是治疗急性A型主动脉夹层的主要手段之一。由于需要在开放下吻合降主动脉与人工血管,这导致无法正常灌注而引起机体缺血。为减轻缺血对机体的损伤,体外循环经历了3个阶段:第一阶段为深低温全身停循环阶段。它使全弓置换手术成为可能,但带来较高的死亡率和神经系统并发症;第二阶段增加了选择性脑灌注,它使死亡率和神经系统并发症发生率显著下降,但此期下半身缺血导致的腹腔脏器损伤尤为突出。第三阶段为全身灌注阶段。笔者提出下腔静脉逆行灌注联合顺行脑灌注,为减少手术后并发症带来新的曙光。

Total aortic arch replacement is one of the main therapies to treat acute type A aortic dissection.However,ischemic injuries may occur during surgery,because of the anastomose of descending aorta and artificial graft,during which perfusion can not be performed.In order to attenuate ischemic injuries,cardiopulmonary bypass undergoes three stages.First,deep hypothermia circulatory arrest makes surgery possible,but it is followed by high incidences of mortality and neurological complications.Second,selective cerebral perfusion significantly improves the outcomes regarding to low mortality and neurological complications.However,organ injuries in the abdominal cavity are prominent due to the inadequate perfusion for the lower body during this stage.This can be avoided in the third stage.In this stage,we recently proposed retrograde inferior vena cava perfusion combined with antegrade cerebral perfusion,which would bring a light to further improve clinical outcomes.