单侧与双侧顺行性脑灌注的前瞻性随机对照研究

目的 比较全主动脉弓替换术中单侧顺行性脑灌注（ASCP）和双侧ASCP的脑保护效果。方法 16例全主动脉弓替换术病人随机分为单侧ASCP组和双侧ASCP组，每组各8例。两组均行术前、术后颅脑计算机体层摄影（CT）、术中均动态监测无名动脉及左颈总动脉压力，均行颈内静脉球血样血气分析。结果 两组各有1例出现短暂性神经功能异常。在ASCP期间单侧组无名动脉压高于左颈总动脉压（P〈0．01），而双侧组无名动脉压与左颈总动脉压相同。两组间各时间段颈静脉血氧分压、颈静脉血氧饱和度差异无统计学意义（P〉0．05）。结论 在基底动脉环完整，存在有效侧支循环条件下，单侧ASCP及双侧ASCP均能取得良好效果。单侧灌注操作较为简便，双侧灌注在ASCP期间两侧灌注压较为均衡，双侧灌注是否增加脑栓塞的危险尚需进一步研究。

Prospective randomised comparative study of brain unilateral or bilateral antegrade selective cerebral perfusion protection in total aortic arch replacement

Objective To compare the cerebral protection effect of unilateral and bilateral antegrade selective cerebral perfusion during total aortic arch replacement. Methods From June 2003 to March 2004, 16 patients undergoing total aortic arch replacement were divided into two groups, randomized: unilateral antegrade selective cerebral perfusion (unilateral group, n=8) and bilateral antegrade cerebral perfusion (bilateral group, n=8). Preoperative and postoperative brain CT scan were performed. During the operation, the pressure in innominate artery and left common carotid artery were monitored. Blood gas samples were drawn from jugular venous bulb. Results There was no postoperative death and all patients were discharged from hospital. No new brain infarction occurred. Transient neurological dysfunction occurred in 1 patient of each group. In unilateral group, the pressure in innominate artery was higher than that in left common carotid artery during antegrade selective cerebral perfusion (P<0.01). In bilateral group, the bilateral perfusion pressure was about the same during antegrade selective cerebral perfusion. There were no intergroup differences in jugular venous oxygen tension, and oxygenation saturation (P>0.05). Conclusion Both methods of brain protection for patients undergoing total aortic arch replacement resulted in favorable levels of mortality and morbidity. The circle of Willis was patent and collateral flow was adequate. Unilateral antegrade selective cerebral perfusion has the advantage of simplicity. The bilateral perfusion pressure was more even in bilateral antegrade selective cerebral perfusion, and whether bilateral antegrade selective cerebral perfusion carry a higher risk of embolism need further investigation.