Objective To assess retrospectively the effects of different protective methods on brain in ascending aortic aneurysm surgery. Methods In 65 patients, aneurysm was dissected to the aortic arch or right arch. To protec...Objective To assess retrospectively the effects of different protective methods on brain in ascending aortic aneurysm surgery. Methods In 65 patients, aneurysm was dissected to the aortic arch or right arch. To protect brain, deep hypotermic circulatory arrest ( DHCA.) combined with retrograde cerebral perfusion ( RCP) June 2003 Vol11 No2 through the superior vena cava ( n = 50) and simple DHCA ( n = 15) were used during the procedure. Blood samples for lactic acid level from the jugular vein were compared in both groups at different plase, and perfusion blood distribution and oxygen content difference between the perfused and returned blood were measured in some RCP patients. Results The DHCA time was 35.9 ± 8 min (10. 0 - 63. 0 min) and DHCA+ RCP time was 45.5 ± 17. 2 min (16. 0 - 81. 0 min)The resuscitationtime was 7.1 ± 1.6 h (4.4 - 9.4H)in DHCA patients and 5.4±2.2h(2.0-9.0 h)in RCP patients. Operation death was 3/15 in the DHCA group and 1/50 in the RCP patients. Central nervous complication展开更多
BACKGROUND Persistent left superior vena cava(PLSVC),a relatively rare thoracic vascular malformation,can inconvenience perfusionists and operators when encountered during deep hypothermic circulatory arrest(DHCA).CAS...BACKGROUND Persistent left superior vena cava(PLSVC),a relatively rare thoracic vascular malformation,can inconvenience perfusionists and operators when encountered during deep hypothermic circulatory arrest(DHCA).CASE SUMMARY Herein,we describe the case of a patient with concurrent giant aortic arch aneurysm,aortic stenosis,and PLSVC.To treat these conditions,we performed right hemiarch and aortic valve replacements under DHCA.Notably,we applied“bilateral superior vena cava retrograde cerebral perfusion(RCP)”for cerebral protection,which significantly optimized the surgical procedure and reduced the risk of postoperative complications.The patient was discharged 14 d after surgery with no complications.CONCLUSION Surgical intervention for PLSVC under DHCA can be performed using the bilateral superior vena cava RCP approach.展开更多
目的观察深度低体温停循环技术对脑组织代谢及结构的影响。方法18只实验犬随机分为3组,深度低体温停循环(deep hypothem ic c ircu latory arrest,DHCA)组,深度低体温停循环结合逆行脑灌注(retrograde cerebralperfusion,RCP)组,深度低...目的观察深度低体温停循环技术对脑组织代谢及结构的影响。方法18只实验犬随机分为3组,深度低体温停循环(deep hypothem ic c ircu latory arrest,DHCA)组,深度低体温停循环结合逆行脑灌注(retrograde cerebralperfusion,RCP)组,深度低体温停循环结合顺行间断脑灌注(interm ittent antegrade cerebral perfusion,IACP)组,每组6只。3组动物体外循环开始后将鼻咽温降至18℃,随后停循环90m in;开放循环后逐步复温至鼻咽温到36℃,随后停机。3组动物在停循环前(T1),停循环后45 m in(T2)、90 m in(T3)及开放循环后15 m in(T4)和30 m in(T5)分别由股动脉和颈静脉插管留取血液标本进行pH值和乳酸测定。手术结束时取脑海马组织作透射电镜检查,观察脑组织及神经细胞超微结构的变化。结果3组动物在停循环前脑组织的pH值无显著差异;停循环后DHCA组和RCP组脑组织pH值比停循环前显著降低,而IACP组pH值无显著差异。3组动物在停循环前动脉血和颈静脉血的乳酸含量无显著差异;停循环后DHCA组和RCP组颈静脉乳酸含量比停循环前显著升高,也比IACP组显著升高;IACP组颈静脉乳酸含量仅在停循环90 m in(T3)时比停循环前有显著升高,恢复循环后很快降至停循环前水平。DHCA组及RCP组神经细胞及细胞核肿胀明显,而IACP组水肿不明显。结论单纯DHCA时间较长时,脑组织内产生大量乳酸,使脑组织呈酸性状态;RCP对脑组织有一定的保护作用,但易发生脑组织及神经细胞水肿;IACP的脑保护效果较为理想。展开更多
文摘Objective To assess retrospectively the effects of different protective methods on brain in ascending aortic aneurysm surgery. Methods In 65 patients, aneurysm was dissected to the aortic arch or right arch. To protect brain, deep hypotermic circulatory arrest ( DHCA.) combined with retrograde cerebral perfusion ( RCP) June 2003 Vol11 No2 through the superior vena cava ( n = 50) and simple DHCA ( n = 15) were used during the procedure. Blood samples for lactic acid level from the jugular vein were compared in both groups at different plase, and perfusion blood distribution and oxygen content difference between the perfused and returned blood were measured in some RCP patients. Results The DHCA time was 35.9 ± 8 min (10. 0 - 63. 0 min) and DHCA+ RCP time was 45.5 ± 17. 2 min (16. 0 - 81. 0 min)The resuscitationtime was 7.1 ± 1.6 h (4.4 - 9.4H)in DHCA patients and 5.4±2.2h(2.0-9.0 h)in RCP patients. Operation death was 3/15 in the DHCA group and 1/50 in the RCP patients. Central nervous complication
基金Technology Innovation and Application Development Project of Chongqing,No.2021yc-cxfz30016.
文摘BACKGROUND Persistent left superior vena cava(PLSVC),a relatively rare thoracic vascular malformation,can inconvenience perfusionists and operators when encountered during deep hypothermic circulatory arrest(DHCA).CASE SUMMARY Herein,we describe the case of a patient with concurrent giant aortic arch aneurysm,aortic stenosis,and PLSVC.To treat these conditions,we performed right hemiarch and aortic valve replacements under DHCA.Notably,we applied“bilateral superior vena cava retrograde cerebral perfusion(RCP)”for cerebral protection,which significantly optimized the surgical procedure and reduced the risk of postoperative complications.The patient was discharged 14 d after surgery with no complications.CONCLUSION Surgical intervention for PLSVC under DHCA can be performed using the bilateral superior vena cava RCP approach.
文摘目的观察深度低体温停循环技术对脑组织代谢及结构的影响。方法18只实验犬随机分为3组,深度低体温停循环(deep hypothem ic c ircu latory arrest,DHCA)组,深度低体温停循环结合逆行脑灌注(retrograde cerebralperfusion,RCP)组,深度低体温停循环结合顺行间断脑灌注(interm ittent antegrade cerebral perfusion,IACP)组,每组6只。3组动物体外循环开始后将鼻咽温降至18℃,随后停循环90m in;开放循环后逐步复温至鼻咽温到36℃,随后停机。3组动物在停循环前(T1),停循环后45 m in(T2)、90 m in(T3)及开放循环后15 m in(T4)和30 m in(T5)分别由股动脉和颈静脉插管留取血液标本进行pH值和乳酸测定。手术结束时取脑海马组织作透射电镜检查,观察脑组织及神经细胞超微结构的变化。结果3组动物在停循环前脑组织的pH值无显著差异;停循环后DHCA组和RCP组脑组织pH值比停循环前显著降低,而IACP组pH值无显著差异。3组动物在停循环前动脉血和颈静脉血的乳酸含量无显著差异;停循环后DHCA组和RCP组颈静脉乳酸含量比停循环前显著升高,也比IACP组显著升高;IACP组颈静脉乳酸含量仅在停循环90 m in(T3)时比停循环前有显著升高,恢复循环后很快降至停循环前水平。DHCA组及RCP组神经细胞及细胞核肿胀明显,而IACP组水肿不明显。结论单纯DHCA时间较长时,脑组织内产生大量乳酸,使脑组织呈酸性状态;RCP对脑组织有一定的保护作用,但易发生脑组织及神经细胞水肿;IACP的脑保护效果较为理想。
