双侧深低温停循环顺行性脑灌注对主动脉弓替换术患者脑损伤的影响

目的 探讨双侧深低温停循环(Deep hypothermia and circulatory arrest,DHCA)+顺行性脑灌注(Anterograde cerebral perfusion,ACP)对主动脉弓替换术患者脑损伤的影响。方法 选择2018年1月-2020年1月本院实施主动脉弓替换术的DebakeyⅠ型主动脉夹层患者96例,根据不同的脑保护技术将患者分为单侧ACP组和双侧ACP组,各48例; 2组均进行DHCA,单侧ACP组经右侧腋动脉进行单侧ACP,双侧ACP组经右侧腋动脉和左颈总动脉进行双侧ACP。结果 全部患者痊愈出院,出院前CT复查显示主动脉弓和升主动脉的人工血管血流畅通,无人工血管扭曲和造影剂渗漏等状况。双侧ACP组术后短暂性脑损伤发生率为2.08%(1/48),明显低于单侧ACP组的16.67%(8/48)(P<0.05)。双侧ACP组术后苏醒时间为(13.18±3.42)h,明显短于单侧ACP组的(16.98±4.18)h(P<0.05)。体外循环开始后2组血清神经元特异性烯醇化酶(Neuron-specific enolase,NSE)、中枢神经特异性蛋白 100-β亚型(Specific protein 100-β,S100-β)水平均逐渐升高,且在体外循环结束时达到峰值,随后开始降低; 脑灌注5min后双侧ACP组血清NSE,S-100β水平明显低于单侧ACP组(P<0.05)。结论 双侧深低温停循环顺行性脑灌注对主动脉弓替换术患者脑损伤的影响程度更小,其机制可能是通过降低血清NSE,S-100β水平,进而有效保护脑组织。

The influence of bilateral deep hypothermic circulatory arrest with anterograde cerebral perfusion on brain injury in patients undergoing aortic arch replacement

ObjectiveTo investigate the influence of bilateral deep hypothermic circulatory arrest(DHCA)with anterograde cerebral perfusion(ACP)on brain injury in patients undergoing aortic arch replacement.Methods 96 patients with Debakey I aortic dissection undergoing aortic arch replacement in our hospital from January 2018 to January 2020 were enrolled. According to the different types of brain protection techniques, the patients were divided into unilateral ACP group(n=48)and bilateral ACP group(n=48). Both groups were given DHCA. In unilateral ACP group, patients underwent unilateral ACP through right axillary artery. In bilateral ACP group, patients underwent bilateral ACP through right axillary artery and left common carotid artery.Results All patients were cured and discharged from hospital. The CT reexamination before discharge showed normal blood flow of artificial aorta blood vessels. And there is no artificial vessel distortion or contrast leakage. The incidence of postoperative transient brain injury in the bilateral ACP group(2.08%,1/48)was significantly lower than that in the unilateral ACP group(16.67%, 8/48)(P<0.05). The postoperative recovery time in the bilateral ACP group was(13.18±3.42)hrs, which was significantly shorter than that in the unilateral ACP group(16.98±4.18)hrs(P<0.05). Plasma NSE and S-100β levels in both groups increased gradually from the beginning of extracorporeal circulation, reached a peak at the end of extracorporeal circulation and then began to decrease thereafter. After 5min of cerebral perfusion, plasma NSE and S-100β levels in the bilateral ACP group were significantly lower than those in the unilateral ACP group, and the differences between the two groups were significant(P<0.05).Conclusion Bilateral deep hypothermic circulatory arrest with anterograde cerebral perfusion imposed lessinfluence on brain injury in patients undergoing aorticarch replacement, and it could significantly reduce plasma NSE and s-100 levels, thus effectively protecting brain tissue, which is worthy of clinicalapplication.