经右腋动脉选择性脑灌注在主动脉夹层手术中的应用

目的总结右腋动脉插管体外循环(ECC)、选择性顺行脑灌注在主动脉夹层手术中应用的初步经验。方法回顾性分析我院2005年1月—2008年7月采用深低温停循环(DHCA)加右腋动脉插管选择性顺行脑灌注(ASCP)手术治疗I型主动脉夹层10例。男8例,女2例。年龄24~63岁,平均(41.7±12.0)岁。升主动脉+全弓置换+降主动脉术中支架置入术5例,升主动脉+全弓置换2例,升主动脉+右半弓置换3例。结果本组主动脉阻断时间83~258min,平均(132.3±52.8)min。深低温停循环时间8~53min,平均(29.10±18.30)min,选择性脑灌注时间8~58min,平均(33.4±18.5)min。手术死亡2例,1例因术中出血、体外循环时间长不能脱机,1例因术后低心排和多脏器功能衰竭。术后暂时性脑损害2例,均治愈出院,无永久性脑损害发生。结论右腋动脉插管灌注和顺行脑灌注在主动脉夹层手术中可提供有效的脑保护,其操作简便、安全。

Antegrade Selective Cerebral Perfusion via Right Axillary Artery for Surgical Operation of Aortic Dissection

Objective To summarize the perfusion experience in aortic dissection using antegrade selective cerebral perfusion with right axillary artery perfusion.Methods From January 2005 to July 2008,ten patients with aortic dissection,who underwent surgery with right axillary artery perfusion for cerebral protection,were studied.The age of the ten patients ranged from 24 to 63 years with an average of 41.7±12.0 years.Surgical procedure included ascending and total arch grafting with stent elephant trunk technique in five,ascending and total arch grafting in two,and ascending and hemiarch grafting in three cases.Results Mean aortic cross-clamping time was 132.3±52.8 minutes(range 83 to 258 minutes).Mean deep hypothermia cardiac arrest time was 29.1±18.30 minutes(range 8 to 53 minutes).The mean period of antegrade selective cerebral perfusion through right axillary artery was 33.4±18.5 minutes(range 8 to 58 minutes).One died of excessive bleeding and weaning failure,and another one died of low cardiac output and subsequent multiorgan failure.Two patients experienced temporary neurologic dysfunction and recovered before admission.No permanent neurologic dysfunction was found.Conclusion Our outcome suggests that right axillary artery perfusion in conjunction with selective cerebral perfusion may be the optimal technique for brain protection in operation for aortic dissection.The technique is safe and related to a significant improvement in clinical outcome.