胸主动脉瘤术中预防脑损伤的研究

目的 对胸主动脉瘤术中脑损伤的预防进行临床研究。方法 对72例主动脉弓部和近弓部主动脉瘤患者采取选择性锁骨下动脉脑灌注、深低温停循环(DHCA)、DHCA 上腔静脉逆行灌注等方法实施脑保护。结果 术后7例出现暂时性脑功能障碍，神志分别于术后4～7天恢复。3例并发脑损伤死亡。随访3个月至11年，术后短暂性脑功能障碍患者神经功能正常。结论 ①选择性锁骨下动脉脑灌注符合解剖、生理。手术野清晰，可有效实施脑保护，避免脑损伤，是主动脉弓部和近弓部主动脉瘤手术首选脑保护措施。②提高手术技术，缩短手术时间，尤其缩短非生理性灌注时间是减少术后脑损伤的重要措施。     

大血管手术低温停循环下顺、逆行脑灌注的荟萃分析

目的比较低温停循环下应用顺行性或逆行性脑灌注进行大血管手术患行的临床结果。方法我们对PubMed,Embasr和the Cochrahe Library数据库进行了检索。纳入的研究对象要分别采用低温停循环（HCA）＋顺行性脑灌注（ACP）和低温停循环（HCA）＋逆行性脑注行（RCP）进行大血管手术,并且研究报道了早期死亡率、中风率、短暂性神经功能障碍（TND）、永久性神经功能障碍（PND）中至少一个作为临床终点的原始数据。我们通过Q检验和12检验进行异质性分析．运用Begg’s检验和Egger’s检验分析有无出版偏倚。结果最终有31篇文章纳入此荟萃分析,其中4300名患者使用HCA＋ACP,2662名使用HCA＋RCP。TND的合并RR为0．806,95％CI：[0．640.1．015],Z值为1．84（p=0．066）,PND的合并RR为0．974,95％CI=[0．713．1．332],Z值为0．16（p=0．87）。早期死亡率的合并RR为1．152,95％CI=[0．935,1．420],Z值为1．33（p=0．185）。中风结果的合片RR为1．393,95％CI=[0．755,2．569],Z值为1．06（p=0．288）。结果强示各组间均无显著性差异。结论大血管手术中运用HCA＋ACP或HCA＋RCP在比较TND,PND,早期死亡率和中风率这些临床终点时没有显著统计学差异。     

深低温停循环与区域性脑灌注婴儿学龄前社会生活能力随访

目的评估心血管手术中使用深低温停循环（deephypothermiccirculatoryarrest,DHCA）与区域性脑灌注（regionalcerebralperfusion,RCP）的婴儿学龄前社会生活能力水平,评价DHCA与RCP的脑保护效果。方法选取2007年4月至2009年2月在广东省人民医院接受DHCA和RCP行主动脉合并心内畸形矫治手术的患儿（日龄≤90d或体质量≤6．0kg）,排除死亡及失访患儿后,参与随访的共32例,男26例,女6例;手术日龄14-187d,中位日龄55d;手术时体质量（4．2±0．8）kg。其中,DHCA组15例,RCP组17例,随访时间分别为（57．2±5．9）个月与（53．2±9．4）个月。采用从《婴儿-初中生社会生活能力量表》,从独立生活、运动、作业操作、交往、集体活动、自我管理6个方面对患儿进行评估,测出其社会生活能力水平。结果DHCA组有1例患儿术后反复肺炎,生长发育差．作业操作、交往能力评分等级为轻度低下,独立生活、运动、集体活动、自我管理评分为边缘;另1例患儿集体活动评分为边缘。RCP组有l例患儿交往能力评分为边缘。其余患儿在作业操作、交往、独立生活、运动、集体活动、自我管理6个方面社会生活能力均正常。两组患儿在作业操作、交往、独立生活、运动、集体活动、自我管理6个方面评分比较,差异均无统计学意义（P〉0．05）。结论婴幼儿主动脉手术使用DHCA与RCP对患儿学龄前社会生活能力无明显影响．DHCA与RCP有相似的脑保护效果。     

Retrograde cerebral perfusion as an adjunct to prolonged hypothermic circulatory arrest.

STUDY OBJECTIVE: This study was designed to evaluate the use of retrograde cerebral perfusion (RCP) combined with deep hypothermic circulatory arrest (DHCA) in the treatment of complex congenital and adult cardiac disease. DESIGN: Retrospective chart review of 52 cardiac surgery patients (34 male and 18 female; age range, 3 weeks to 89 years old; mean age, 60 years old) who received RCP in conjunction with DHCA from July 1991 through August 1998. RESULTS: Surgical procedures consisted of the following: (1) repair of ascending aortic aneurysms (n = 16); (2) repair of type A aortic dissection (n = 16); (3) repair of arch aneurysms (n = 10); (4) renal cell carcinoma with tumor extension to the inferior vena cava (IVC) and right atrium (n = 5); (6) coronary artery bypass grafting and concomitant aortic valve replacement with calcified aorta (n = 2); (7) Norwood procedure and take down of a Pott's shunt (n = 2); and (8) massive air embolism treatment (n = 1). Mean RCP time was 39 min (range, 3 to 88 min). Thirteen patients had RCP times > 60 min. Mean core temperature (rectal or bladder) was 19 degrees C (range, 15 degrees to 28 degrees C). There were six early deaths, four of which were related to persistent low-output cardiac failure, and two resulted from perioperative stroke. All remaining patients recovered fully without neurologic deficits. CONCLUSION: RCP is a reliable and technically appealing tool that does the following: (1) it improves DHCA safety and is applicable in a variety of clinical settings with relative ease; (2) it potentially provides oxygen and nutritional support to the brain during DHCA; (3) it helps remove air and other debris from the cerebral vessels; and (4) it is useful in dealing with congenital heart disease and tumor extension into the IVC.     

升主动脉瘤累及右半弓的外科治疗及体外循环探讨

目的:总结升主动脉及右半弓置换术的外科治疗经验,探讨不同体外循环(CPB)方式在术中的应用。方法:28例升主动脉瘤伴右半弓受累的患者行升主动脉及右半弓置换术,其中8例单纯经股动脉与右心房插管建立CPB,在深低温停循环(DHCA)下开放吻合主动脉弓和人工血管远端;15例经右腋动脉或无名动脉及股动脉与右心房插管建立CPB,在中深低温选择性脑灌注(ACP)加全身停循环下开放吻合主动脉弓和人工血管远端;5例经股动脉右心房插管的同时,经腋动脉或无名动脉插管浅低温全流量下行ACP加下半身股动脉逆行灌注,在无名动脉和左颈总动脉之间阻断主动脉弓后吻合主动脉弓和人工血管远端。结果:术后突发大面积心肌梗死造成心源性休克死亡1例。术后偏瘫经CT确诊为脑梗死2例。呼吸功能不全需2次气管插管1例,机械通气辅助24h病情改善后脱离呼吸机。术后出现严重高钠血症需进行血滤1例。2次开胸止血1例。结论:在主动脉右半弓置换术CPB方法的选择上,外科医生和灌注师需根据患者病情、手术熟练程度正确掌握DHCA和ACP技术,选择最佳的灌注方式。     

选择性脑灌注在主动脉手术中的应用

目的探讨中低温选择性脑灌注在主动脉手术应用的安全性及优越性。方法回顾性分析2006年1月～2009年6月在广东省人民医院行升主动脉和主动脉弓手术的108例患者[根据脑保护方法的不同分为深低温停循环组(32例)、深低温选择性脑灌注组(35例)、中低温选择性脑灌注组(41例)]的临床资料、体外循环方法和时间、病死率及并发症发生率等,并进行统计学分析。结果中低温选择性脑灌注组体外循环时间低于深低温停循环组和深低温选择性脑灌注组,差异有统计学意义[(184.56±24.01)min vs.(216.94±25.22)min vs.(200.09±23.80)min,P<0.05];再次开胸率也低于其他两组,差异有统计学意义[4.9%(2/41) vs.14.3%(5/35) vs.25.0%(8/32),P<0.05]。术后呼吸功能不全、肾功能衰竭、感染、腹部并发症和截瘫的发生率比较,差异无统计学意义(P>0.05)。3组住院病死率、一过性和永久性神经系统并发症的发生率比较,差异无统计学意义(P>0.05)。结论中低温选择性脑灌注是一种安全有效的脑保护方法,缩短了体外循环时间,降低了术后再次开胸率。     

上腔静脉逆行灌注在胸主动脉夹层瘤手术中的应用

目的：探讨安全、实用和适合胸主动脉瘤手术操作的体外循环灌注方案。方法：在深低温停循环（DHCA）基础上，用上腔静脉逆行灌注的体外循环方法，进行了2例Bentall手术和1例弓降部主动脉移植重建，对上腔静脉逆行灌注的管道连接、灌注条件控制及逆灌过程中进出脑的血氧含量，病人瞳孔变化，术后清醒时间和恢复情况进行总结。结果：上腔静脉逆行灌注时间36～68分，逆灌期间进、出脑血氧差28．8～59．3ml／L；瞳孔直径散大至4～10mm；第1、2例病人清醒时间分别为术后4小时15分和2小时35分，无手术并发症，于术后第24天和第10天痊愈出院；第3例因术后反复心律失常和严重低心排于手术当天在ICU死亡。结论：上腔静脉逆行灌注使脑组织得到必须的动脉血供，是一种有效延长DHCA时间并适合胸主动脉瘤手术特点的体外循环灌注方法。     

深低温停循环下犬海马组织神经细胞凋亡及脑保护的实验研究

目的观察深低温停循环下犬海马组织中神经细胞凋亡情况及对凋亡相关基因bcl-2和bax表达的影响,探讨间断选择性顺行脑灌注对深低温停循环的脑保护机制。方法健康成年杂种犬（1822 kg）18只,随机均分为3组:对照组即常温体外循环组（A组）;深低温停循环（deep hypotherm ic c ircu latory arrest,DHCA）组（B组）;深低温停循环+间断选择性顺行脑灌注（interm ittent selective antegrade cerebral perfusion,ISACP）组（C组）。术后取出海马组织,采用SABC法观察海马组织bcl-2和bax表达情况。在透射电镜（TEM）下观察海马组织的细胞形态学变化。结果电镜下,A组无神经细胞凋亡,B组可见明显神经细胞凋亡改变,C组仅见少量神经细胞凋亡。SABC法观察显示在B组中,bax表达明显高于其它两组（P<0.01）,而在C组中bcl-2表达明显高于其它两组（P<0.01）。结论深低温停循环下,bax表达增强,使得凋亡发生,而在深低温停循环下给予间断选择性顺行脑灌注时,bcl-2表达增强,bax表达减弱,从而抑制了神经细胞凋亡的发生,具有脑保护作用。     

大血管手术在不同停循环温度下顺行性脑灌注的荟萃分析

目的深低温停循环(DHCA)联合顺行性选择性脑灌注(ASCP)技术是目前大多数心脏中心主动脉弓部手术时采用的体外循环技术。但随着凝血、炎症反应、器官功能损伤等问题的日益彰显,人们对采用深低温的必要性逐渐产生质疑。本篇荟萃分析将不同停循环温度下应用顺行性脑灌注的大血管手术患者的临床结果进行比较分析。方法我们对Pub Med,Embase,the Cochrane Library,谷歌学术及万方、维普、中国知网等国内数据库进行了检索。将不同停循环温度下顺行性脑灌注的大血管手术的研究纳入本荟萃分析,并且纳入的研究需报道了相应的临床结果。我们通过Q检验和I2检验进行异质性分析,运用Begg’s检验和Egger’s检验分析有无发表偏倚。结果本荟萃分析共纳入13篇研究,共2531人,其中305名患者采用了DHCA+ASCP,1167名采用中低温停循环(MHCA)+ASCP,1059名患者采用浅低温停循环(mild HCA)+ASCP。对深低温组与中低温组对比分析,深低温组的早期死亡率显著高于中低温组,而永久性神经功能障碍(PND),短暂性神经功能障碍(TND)及肾衰结果无显著性差异。对中低温组与浅低温组对比分析,浅低温组TND,肾衰,出血再次开胸的发生率均低于中低温组,而早期死亡率与PND无明显差异。结论 MHCA+ASCP在早期死亡率方面优于DHCA+ASCP。而mild HCA+ASCP在TND,肾衰,因出血再次开胸方面均优于MHCA+ASCP,其他结果无显著差异。因此,对于在停循环过程中应用顺行性脑灌注实施主动脉手术的患者,适当提高停循环温度是相对安全并值得积极推荐的。     

六月龄以下婴儿体外循环探讨

目的探讨六月龄以下婴儿的体外循环方法和效果。方法对我院1996年8月至2005年7月施行的168例六月龄以下婴儿心脏手术的体外循环方法予以回顾性总结。结果本组168例婴儿体外循环手术,分别应用深低温停循环灌注法、低温低流量灌注、中度低温停跳体外循环及浅低温不停跳法体外循环。死亡25例,转流时间长,术后低心排,肾衰为主要死因。结论六月龄以下婴儿体重小、血容量少、组织器官发育不成熟,选择适当的体外循环方法,重视心肺功能的保护是确保体外循环成功的关键。     

Cannulation in the diseased aorta: a safe approach using the Seldinger technique

The Seldinger technique is a method of femoral cannulation that has been used to establish cardiopulmonary bypass. Reports of cannulation of the ascending aorta for antegrade perfusion using the Seldinger method are anecdotal. To the best of our knowledge, the approach described herein for direct cannulation of the ascending aorta with use of the Seldinger technique for antegrade perfusion has not been previously described in the English-language medical literature. This method is helpful when the surgeon is treating a patient who has a calcified ascending aorta, complicated aortic dissection, calcified femoral vessels, or a diseased thoracoabdominal aorta. In such cases, retrograde perfusion has been associated with severe complications as a result of atheromatous embolization from the descending thoracic aorta. Herein, we describe our approach to cannulation for cardiopulmonary bypass, which entails insertion of an aortic cannula into the ascending aorta by means of the Seldinger technique. A soft-tip guidewire is inserted through an arterial entry catheter that has been used to puncture a hole in the wall of the vessel. Then the aortic cannula is introduced into the vessel, sliding along the guidewire. Guided by transesophageal echocardiography, the tip of the cannula is positioned carefully and is then advanced into the descending aorta. This positioning of the cannula decreases the chance of arterial embolization, thereby improving cerebral protection. If cannulation of the ascending aorta is not feasible, the transverse aortic arch or proximal descending aorta can be used.     

Cerebral protection during surgery of the thoracic aorta: a review.

Operations on the aortic arch remain a major challenge for the cardiac surgeon and neurologic injuries represent the most feared complication. During the last decades, different cerebral protection techniques, including deep hypothermic circulatory arrest, and retrograde and antegrade cerebral perfusion have been introduced into clinical practice to reduce the incidence of such complications. All three methods present advantages and disadvantages. In this review, the theoretical impact of the current methods of brain protection is reported and discussed.     

中度低温停循环脑保护研究进展

主动脉弓部手术是治疗StandfordA型主动脉夹层的主要方法,该手术中脑保护的最佳方式临床上上存在争议。深低温停循环一直是进行主动脉弓部手术的基础,随着研究的深入,深低温的弊端逐渐被认识,中度低温停循环开始应用于主动脉弓部手术。本文主要对此进行综述。     

中度低温停循环结合选择性脑灌注在婴儿主动脉弓部手术中的应用

目的 总结中度低温停循环(moderate hypothermia circulatory arrest,MHCA)结合选择性顺行脑灌注(sective antegrade cerebral perfusion,SACP)技术在婴儿主动脉弓重建手术中的应用经验.方法 回顾性分析上海市儿童医院心胸外科于2012年1月至2018年12月间完成的主动脉弓病变合并心内畸形矫正的患儿50例.依据中心温度将患儿分为深低温停循环(deep hypothermia circulatory arrest,DHCA)组及MHCA组,每组25例.所有患儿均在体外循环(cardiopulmonary bypass,CPB)下行一期手术治疗.主动脉弓重建过程中采用低温停循环技术,通过无名动脉SACP(25~40 ml·kg^-1·min^-1)的CPB管理方法.心肌保护采用康斯特器官保护液(HTK液).记录两组患者的一般资料及术中、术后指标.结果 两组均无与CPB相关的神经系统并发症.两组患儿年龄、体重、病种、术前肝肾功能及术前左心室射血分数值比较差异均无统计学意义(P>0.05).CPB时间MHCA组较DHCA组明显缩短[(120.00±22.60)min比(137.40±22.88)min,P=0.019];术后24 h胸腔引流量及正性肌力药物评分MHCA组较DHCA组明显减少,分别为[(49.84±20.66)ml比(78.20±52.31)ml,P=0.03;(9.72±2.47)分比(12.24±3.07)分,P=0.004].结论 在婴儿主动脉弓重建手术中,采用DHCA或MHCA结合SACP的技术均能均减少术后神经系统并发症发生,不增加术后其他并发症.MHCA可减少CPB时间、术后胸腔引流量及术后血管活性药物的使用量.     

The effect of FR167653 on cerebral ischemia-reperfusion injury after retrograde cerebral perfusion in a canine model

Retrograde cerebral perfusion (RCP) has recently been reported to be useful for the repair of aortic arch aneurysms. However, there is a possibility that RCP supplies a limited amount of blood to the brain [1] and ischemia-reperfusion injury may occur after RCP. FR167653 (FR) is characterized as a potent suppressant of interleukin-1 and tumor necrosis factor-. We investigated the role of FR in preventing cerebral ischemia-reperfusion injury after RCP in a canine model. A total of 12 mongrel dogs was divided into two groups: in the FR group (n=6), FR167653 (1 mg/kg/hour) was continuously administered during the period of RCP and rewarming; in the control group (n=6), a physiological saline solution was administered at the same dosage as the FR167653 during the same period. Following hypothermia (20°C) using cardiopulmonary bypass and circulatory arrest, RCP was performed by infusing oxygenated blood via the bilateral internal maxillary veins for 60 minutes at a perfusion pressure of 25 mmHg. The cerebral blood flow (CBF), cerebral metabolic rate for glucose (CMRGlu) and oxygen (CMRO₂), and excretion of carbon dioxide (ExCO₂) were measured. These results were expressed as the percentage of change from baseline values established immediately after anesthesia. CBF was significantly (p<0.05) higher in the FR group than in the control group at 40 (159±25% and 82±21%, respectively) and 60 minutes (177±30% and 83±14%, respectively) after RCP. The lactate/pyruvate ratio of blood returned from the brain tissues was significantly (p<0.05) lower in the FR group than in the control group at 40 and 60 minutes after RCP. CMRGlu was significantly (p<0.05) higher in the FR group than in the control group 60 minutes after RCP. There was no significant difference in CMRO₂ and ExCO₂ between the two groups. It is concluded that FR167653 appears to be effective in protecting the brain from ischemia-reperfusion injury after RCP.Presented in part at the 40th Annual World Congress International College of Angiology, Lisbon, Portugal, June 1998.     

The prediction of the severity of acute pancreatitis by C-reactive protein]

Reactive C Protein (RCP) has been determined in fifty-one patients with acute pancreatitis. RCP has been compared with Ranson's criteria which include several clinical and biochemical parameters. The value of 20 mg/dl is the one which discriminates serious acute pancreatitis from the mild forms in a 84.3% of patients. Sensitivity and specificity of RCP and Ranson's criteria are compared, the results obtained are similar (88.9% vs. 81.8% and 94.4% vs. 97%). In summary, the determination of RCP is very useful for its simplicity and accuracy in the prognosis of acute pancreatitis.     

Optimal brain temperature for retrograde cerebral perfusion in dogs

We investigated the optimal brain temperature during the period of retrograde cerebral perfusion (RCP). Eighteen mongrel dogs were divided into three groups according to brain temperatures during the period of RCP: L (15°C), M (20°C), and H (25°C). Following hypothermia using cardiopulmonary bypass (CPB), RCP was performed for 60 minutes via the bilateral internal maxillary veins with a perfusion pressure of 25 mmHg. The animals were then rewarmed for 60 minutes. Cerebral blood flow (CBF) was measured by laser Doppler flowmetry. The cerebral metabolic rate for oxygen (CMRO₂) and glucose (CMRGlu), excretion of carbon dioxide (ExCO₂), and lactate/pyruvate (L/P) ratio were calculated. During the period of RCP, brain temperature significantly (p<0.05) increased in Group L. CBF, CMRO₂, ExCO₂, and CMRGlu significantly (p<0.05) decreased to less than 20% of the baseline levels during the period of RCP in all groups. After RCP, CBF recovered noticeably beyond the baseline levels in Group M (130%). CMRO₂ and ExCO₂ levels in Groups M and H tended to be higher than those in Group L during the rewarming phase. Increase of CMRGlu immediately after RCP was higher in Group M compared with other groups. The L/P ratio in Group M was lower than that in the other two groups during RCP. In conclusion, the brain temperature in the range 20°C may be suitable for maintaining optimal cerebral metabolic activity for RCP.Presented at the 38th Annual World Congress, International College of Angiology, Köln, Germany, June 1996     

Optimizing cerebral oxygenation during cardiac surgery: a review of experimental and clinical investigations with near infrared spectrophotometry

OBJECTIVES: Near-infrared spectrophotometry (NIRS) is a promising method for non-invasive monitoring of cerebral oxygenation and hemodynamics. This paper reviews studies in which we aimed to validate NIRS in an experimental model of cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) (validation study), use the method in experimental settings to optimize cerebral oxygenation during CPB (oxygenation study), and test its utility during routine cardiac surgery (clinical study). METHODS: Validation study: Forty 8-10 kg piglets underwent 60 min of DHCA at 15 degrees C, were extubated on the first postoperative day, and sacrificed on the 4th postoperative day for histologic investigations. During CPB and DHCA, the animals were investigated by NIRS (monitoring of cerebral oxygenated hemoglobin (HbO2) and oxidized cytochrome aa3 (Cytox)) and magnetic resonance spectroscopy (MRS) (monitoring of cerebral adenosine triphosphate (ATP) and phosphocreatine (PCr). Oxygenation study: A normoxic (n = 5) and a hyperoxic group (n = 5) of piglets underwent 120 min of DHCA and 6 h of reperfusion with NIRS monitoring. Neuronal damage was evaluated by histology. Clinical study: Patients (n = 41) undergoing routine cardiac surgery were investigated by NIRS and neuropsychological testings. RESULTS: Validation study: Reductions of CytOx and HbO2 values were closely correlated with decreases in ATP, PCr, and pHi. The changes in CytOx and PCr showed the strongest correlation (r = 0.623). Maximal CytOx reduction during DHCA predicted brain damage. Oxygenation study: Histology revealed a significant increase in brain damage in the normoxic group. Cytox and HbO2 tended to be lower during DHCA (p = 0.16). Clinical study: During CPB, arterial PCO2, pH and temperature were closely related to CytOx and HbO2. Patients who suffered from neuropsychological deficits had a lower CytOx minimum compared to those without these. CONCLUSIONS: NIRS measurements, especially the CytOx signal, correlate well with high energy phosphates and have a high sensitivity to predict histologic brain damage. NIRS is an important and useful tool in studies investigating cerebral oxygenation during CPB. The CytOx signal predicted impaired neuropsychological outcome in patients. Therefore, the CytOx signal holds much interest for future studies.     

Directed retrograde cerebral protection during moderate hypothermic circulatory arrest

There are many choices for neurologic protection for aortic arch surgery. Although numerous investigators have challenged the efficacy of retrograde cerebral perfusion, we have had good results with our application of this technique. We performed a retrospective review of 8 consecutive patients who underwent surgery from 1 June 2001 through 31 March 2003; the age range was 33 to 97 years. All patients required circulatory arrest and underwent retrograde cerebral perfusion with use of a tourniquet on the patients' left and right arms above the elbow to direct retrograde flow to the brain. Moderate hypothermia (around 24 degrees C nasopharyngeal) was used; circulatory arrest time ranged from 27 to 63 minutes. There was 1 late hospital death due to multiple-organ system failure. There were no neurologic complications (stroke or temporary neurologic dysfunction). There was no substantive neurologic or renal dysfunction in this cohort, in which moderate hypothermia was used. These results are comparable to those reported in the literature for similar patients. We conclude that, for patients who require circulatory arrest, directed retrograde cerebral perfusion at moderate nasopharyngeal hypothermia gives results comparable to those reported with other techniques.     

Stanford A型主动脉夹层手术中的体外循环管理

目的:总结我院165例Stanford A型主动脉夹层手术体外循环管理经验。方法:收集165例Stan-ford A型主动脉夹层患者,实施Wheat、David、Bentall及全弓置换和支架象鼻术等术式。根据术式分别采用常规中低温体外循环,深低温停循环(DHCA)加选择性顺行性脑灌注(SACP)等体外循环灌注方法。其中,主动脉全弓置换术均行右锁骨下动脉与右心房插管建立体外循环,在DHCA加SACP下完成主动脉远端支架植入及弓部血管吻合,期间脑灌注流量5～10ml.kg-1.min-1。术中采用单泵双管及单侧选择性脑灌注、α+pH稳态和高氧血气管理及超滤等技术。结果:体外循环转流时间(197.3±28.3)min、深低温停循环时间(25.3±3.8)min、SACP时间(45.2±7.7)min、心肌阻断时间(86.1±10.8)min。重症监护室时间72～516(181.31)h。院内死亡17例(死亡率11.25%),余134例均痊愈出院,出院时心功能NYHAⅠ～Ⅱ级。结论:正确选择体外循环方法及良好的体外循环管理是Stanford A型主动脉夹层手术成功的保障。主动脉全弓替换术中采用单泵双管及单侧选择性脑灌注、α+pH稳态和高氧血气管理及超滤等技术切实可行,临床预后满意。