胸主动脉瘤手术中中浅低温停循环加顺行性脑灌注技术的应用

目的 评价中浅低温停循环加脑灌注技术用于Ⅰ型夹层动脉瘤手术的临床效果.方法 2007年2月至2009年8月行主动脉弓部置换术60例,按照开始停循环的最低温度分为深度低温组(DH,32例;鼻咽温18～20℃)和中浅低温组(MH,28例;鼻咽温23～25℃).观察两组患者手术及其临床预后.结果 住院病死率3.33%(2/60例),每组各有1例死于多器官功能衰竭;开始选择性脑灌注(ASCP)时MH组的鼻咽温和直肠温度[(23.8±1.9)℃和(26.6 ±2.4)℃]明显高于DH组[(19.7±3.2℃和(22.5±2.2)℃],差异有统计学意义(P<0.05).两组ASCP时间(29.4±9.3)min对(32.9±13.4)min,差异尢统计学意义(P>0.05).MH组患者的复温时间较短,(65.00±13.9)min对(90.3±27.2)min;体外循环转机时间较短,(142.8±34.2)min对(194.1±42.0)min,差异均有统计学意义(P<0.05).两组患者术后无永久性神经系统并发症(PND),暂时性神经系统并发症(TND)的发生率为6.67%(4/60例),其中MH组为7.14%(2/28例),DH组为6.25%(2/32例),差异无统计学意义(P>0.05).术后呼吸机辅助通气时间、肾脏功能衰竭发生率、监护室停留时间和住院时间差异无统计学意义(P>0.05).结论 中浅低温加选择性脑灌注用于Ⅰ型夹层动脉瘤手术可以缩短体外循环转机时间,未增加患者术后神经系统并发症.

Abstract：

Objective To compare the effects of hypothermic arrest circulation ( HAC) with moderate or deep hypothermic antegrade selective cerebral perfusion ( ASCP) technique in patients with DeBake type Ⅰ aortic dissection or aortic arch aneurysm undergoing total aortic arch replacement. Methods Between Feb. 2007 and Aug. 2009, 60 patients who underwent aortic arch replacement using HAC + SCP technique. Patients were divided into two groups according to the lowest nasopharyngeal temperature: moderate hypothermia (18 - 20℃) (group MH, n = 28), and deep hypothermia (23 -25 ℃) (group DH,n=32). The clinical and neurological outcomes were observed. Results The overall in-hospital mortality was 3. 33% (2/60) ; In-hospital mortality was 3. 6% in the MH group, while3.1% in the DH group. There were no significant differences regarding to preoperative the patients' character parameters in both groups. At the beginning of ASCP, the nasopharyngeal and rectal temperatures were significantly higher in group MH[MH group (23.8 ± 1. 9 ) ℃ ( 26. 6 ± 2. 4 ) ℃ vs. DH group group (29.4 ±9.3) min vs. DH group(32.9 ± 13.4) min]. The rewarming time and CPB time were significantly shorter in MH group[(65.0±13.9) min vs. (90.3 ±27.2) min; (142.8 ±34.2) min vs. (194.1 ±42.0) min, P <0. 05]. Temporary neurologic deficits occurred in four patients (6. 67% ) without significant differences between two groups ( MH group 7.14% vs. DH group 6. 25% ). No patient suffered from permanent neurologic dysfunction. There were no significant differences between two groups in other parameters including intubation time, kidney insufficiency, the stay times in ICU and hospital. Conclusion Our results demonstrate that moderate HCA + ASCP technique is a safe strategy for the treatment of patients who require conventional total arch replacement with individual arch-vessel reconstruction. Shorter CPB time in patients with moderate HCA + ASCP did not increase any other postoperative adverse effects.

Effects of hypothermic arrest circulation with moderate or deep hypothermic antegrade selective cerebral perfusion technique in patients undergoing total aortic replacement

Objective To compare the effects of hypothermic arrest circulation ( HAC) with moderate or deep hypothermic antegrade selective cerebral perfusion ( ASCP) technique in patients with DeBake type Ⅰ aortic dissection or aortic arch aneurysm undergoing total aortic arch replacement. Methods Between Feb. 2007 and Aug. 2009, 60 patients who underwent aortic arch replacement using HAC + SCP technique. Patients were divided into two groups according to the lowest nasopharyngeal temperature: moderate hypothermia (18 - 20℃) (group MH, n = 28), and deep hypothermia (23 -25 ℃) (group DH,n=32). The clinical and neurological outcomes were observed. Results The overall in-hospital mortality was 3. 33% (2/60) ; In-hospital mortality was 3. 6% in the MH group, while3.1% in the DH group. There were no significant differences regarding to preoperative the patients' character parameters in both groups. At the beginning of ASCP, the nasopharyngeal and rectal temperatures were significantly higher in group MH[MH group (23.8 ± 1. 9 ) ℃ ( 26. 6 ± 2. 4 ) ℃ vs. DH group group (29.4 ±9.3) min vs. DH group(32.9 ± 13.4) min]. The rewarming time and CPB time were significantly shorter in MH group[(65.0±13.9) min vs. (90.3 ±27.2) min; (142.8 ±34.2) min vs. (194.1 ±42.0) min, P <0. 05]. Temporary neurologic deficits occurred in four patients (6. 67% ) without significant differences between two groups ( MH group 7.14% vs. DH group 6. 25% ). No patient suffered from permanent neurologic dysfunction. There were no significant differences between two groups in other parameters including intubation time, kidney insufficiency, the stay times in ICU and hospital. Conclusion Our results demonstrate that moderate HCA + ASCP technique is a safe strategy for the treatment of patients who require conventional total arch replacement with individual arch-vessel reconstruction. Shorter CPB time in patients with moderate HCA + ASCP did not increase any other postoperative adverse effects.