选择性脑灌注对深低温停循环下的脑保护作用

目的总结并分析39例急性DeBakey Ⅰ型主动脉夹层患者在深低温停循环期间选择性脑灌注对脑保护的效果。方法经右锁骨下动脉或升主动脉插灌注管，右心房插引流管建立体外循环。全身降温至鼻咽温28℃时阻断并切开升主动脉，左、右冠状动脉开口灌注冷血心脏停跳液15—20ml／kg，完成近心端处理。鼻咽温18℃，肛温20℃时停体外循环，头部戴冰帽，取20°-30°头低位，阻断主动脉弓三大分支，右锁骨下动脉脑灌注5例，无名动脉和左颈总动脉插管脑灌注34例，灌注流量5—8ml／（kg·min）。结果体外循环转流时间206～256min，平均（230±30）min；主动脉阻断时间95—155min，平均（118±23）min；选择性脑保护灌注时间39—59min，平均（53±14）min。手术死亡3例（7．69％）。一过性精神障碍2例（5．13％）。结论选择性脑灌注能显著降低深低温停循环手术的脑部并发症，有助于改善DeBakey Ⅰ型主动脉夹层患者的手术预后。

Selective cerebral perfusion prevents from cerebral injury during hypothermic circulatory arrest

Objective The effects of selective cerebral perfusion （SCP） on brain protection during hypothermic circulatory arrest were analyzed retrospectively in thirty - nine cases with acute De-Bakey type I aortic dissection. Methods Extracorporeal circulation is established through right subcla- vian artery or femoral artery and right atrium. After nasopharynx temperature reached 28℃, Bentall procedure was completed. When nasopharynx and rectal temperature reached 18℃ and 20℃ respectively,arch replacement and other procedures were performed. Results The period of cardiopulmonary bypass, aortic cross -clamping,and SCP lasted for was 206 -256 min （mean 230 ± 30 min） ,95 ±155 rain （mean 118 ± 23 min）, and 39 -59 min （mean 53± 14 min）. All the patients were successfully treated except 3 cases （7.69%） that died within postoperative 30 days. Temporal spirit disorder occured in 4 cases （ 10.25% ）. Conclusion SCP during hypothermic circulatory arrest prevents ischemia injury in brain and improves the clinical outcome of acute DeBakey type I aortic dissection.