选择性顺行脑灌注及主动脉球囊阻断联合中低温停循环在A型主动脉夹层全弓置换术中的应用初探

目的 探讨选择性双侧脑灌注及主动脉球囊阻断技术联合中低温停循环技术在A型主动脉夹层手术中的效果及可行性。方法 回顾性分析2017年12月—2018年1月收治的10例A型主动脉夹层患者临床资料，患者均在中低温（鼻咽温度28 ℃）停循环下急诊行经典孙氏手术，术中采用选择性双侧脑灌注技术及主动脉球囊阻断。分析手术时间、停循环时间等指标及术后恢复情况。结果 10例患者中无死亡病例发生，均顺利康复出院。术中停循环时间（8.75±1.48）min，转机时间（153.25±15.27）min，阻断时间（94.62±12.24）min，手术时间（377.62±32.71）min。自体血回输（800.0±86.6）mL，未输注异体红细胞等成分血。1例患者术后发生急性肾功能衰竭，其他患者无严重并发症发生。结论 经典孙氏术中采用选择性双侧脑灌注技术及主动脉球囊阻断技术联合中低温停循环技术，可以明显缩短停循环时间及手术时间，术后复苏时间短，神经系统并发症少，手术效果明显，具有一定的临床意义，值得进一步研究。

Preliminary experience of selective antegrade cerebral perfusion and balloon catheterocclusion of descending aorta and moderate hypothermic circulatory arrest inaortic arch surgery of acute type A aortic dissection

Objective To investigate the feasibility and effect of selective antegrade cerebral perfusion (SACP) andballoon catheter occlusion of descending aorta (BCOD) combined with moderate hypothermic circulatory arrest (MHCA) inthe surgical of acute type A aortic dissection (AAAD). Methods The clinical data of 10 patients with AAAD underwentSun’s surgery procedure in Tianjin Chest Hospital from December 2017 to January 2018 were retrospectively analyzed. Allof the patients were treated with classic Sun’s surgery, and SACP+BCOD+MHCA (nasopharyngeal temperature 28 ℃) wereperformed in the surgery. Clinical date and postoperative outcomes of 10 consecutive patients were analyzed. Results Allthe 10 patients were improved or recovered from symptoms. The duration of circulatory arrest, cardiopulmonary bypass,cardiac ischemia and duration of operation were (8.75±1.48) min, (153.25±15.27) min, (94.62±12.24) min and (377.62±32.71) min respectively. The autologous blood transfusion was (800.0 ± 86.6) mL, without allogenic erythrocytes injection.Acute renal failure occurred in 1 patient after operation, and no other significant complications occurred. Conclusion Theclassic Sun’s surgical procedure with SACP+BCOD+MHCA can shorten the duration of circulatory arrest and operationdistinctly. The combination of these techniques results in shorter postoperative recovery time and fewer neurologiccomplications. Therefore, it is of certain clinical significance and worthy of further study.