股静脉-股动脉转流在降主动脉重建术中的作用

目的：评价股静脉－股动脉转流在降主动脉人工血管重建术中的作用。方法：1999年12月至2001年6月间，在股静脉－股动脉转流下行降主动脉人工血管重建术12例为转流组；1994年6月至1999年8月15例降主动脉人工血管重建术为非转流组，比较两组在术后发生截瘫、内脏缺血、输血量和凝血功能异常等方面的差别。资料统计采用t检验或χ^2检验。结果：阻断时间超过60min者中，转流组的截瘫发生低于非转流组（P＜0．05）。转流组术后发生黄疸低于非转流组（P＜0．05），两组在术后肾功能异常上无明显差异（P＞0．05）。转流组输血量较非转流组明显减少（P＜0．01）。转流组术后凝血功能异常发生率低于非转流组（P＜0．05）。结论：股静脉－股动脉转流在预防降主动脉人工血管重建术后的截瘫发生、保护内脏功能、减少输血量和避免凝血功能异常等方面优于单纯阻断降主动脉，是一简便、安全的转流方式。

Femorofemoral cardiopulmonary bypass in descending thoracic aortic reconstruction

Objective: To study the role of femorofemoral cardiopulmonary bypass in descending thoracic aortic reconstruction. Methods: Twelve patients underwent descending thoracic aortic reconstruction under femorofemoral cardiopulmonary bypass between December, 1999 and June, 2001. Fifteen cases of descending thoracic aortic reconstruction between June, 1994 and August, 1999 were selected as non-bypass group. Comparison was made in the two groups in terms of paraplegia, visceral ischemia, blood transfusion and coagulopathy. Results: Femorofemoral cardiopulmonary bypass minimized the likelihood of paraplegia when aortic cross-clamping time exceeded 60 minutes (P<0.05). Abnormal hepatic function occurred less in the bypass group than in the non-bypass group (P<0.05), but no statistical difference was found in abnormal renal function between the two groups (P>0.05). There was significantly less blood transfusion in the bypass group (P<0.01), and more coagulopathies in the non-bypass group (P<0.05). Conclusions: Femorofemoral cardiopulmonary bypass, an easy and safe approach, has significant advantages over simple aortic cross-clamping, in preventing paraplegia and visceral ischemia and reducing blood transfusion and coagulopathy, in descending thoracic aortic reconstruction.