双侧顺行与上腔逆行脑灌注在A型主动脉夹层中应用效果对比的临床研究

目的深低温停循环(DHCA)的同时顺行或逆行脑灌注,是一种行之有效的脑保护方法。在这个回顾性研究中,我们比较顺行、逆行两种方法的临床疗效。方法从2008年10月～2011年1月,63例患者行Stanford A型主动脉夹层手术,均在深低温停循环下行全弓置换。其中选择双侧顺行脑灌注的A组病人54例,B组采用上腔静脉逆灌(RCP)脑保护的病人9例。结果 B组与A组比较在手术时间、体外循环时间、心肌阻断时间、脑灌注时间差异不明显,而B组短暂脑神经功能障碍发生率、拔管时间、ICU滞留时间、住院时间有所增加。结论顺行脑灌注较上腔逆灌降低短暂脑神经功能障碍发生率从而拔管早,缩短ICU及住院时间。

Antegrade Versus Retrograde Cerebral Perfusion in Relation to Postoperative Complications Following Aortic Arch Surgery for Acute Aortic Dissection Type A

ObjectiveAntegrade or retrograde cerebral perfusion (RCP), is a well-established method of brain protection in aortic arch surgery. In this retrospective study, we compard the two methods of brain perfusion.MethodsFrom Oct 2008 to Jan 2011,63 consecutive patients were urgently operated for acute type A aortic dissection and underwent arch replacement under deep hypothermic circulatory arrest (DHCA).Our patient cohort was divided into those protected with antegrade cerebral perfusion (ACP) (group A, n=54) and those protected with RCP (group B, n=9).ResultsThere was no siguificant difference in operative time, cardiopulmonary bypass-time, myocardial blocking time, cerebral-perfusion time between groups B and A,but the incidence of temporary neurologic dysfunction,the mean extubation time,the mean ICU-stay,the hospital-stay increased.ConclusionThe antegrade perfusion was related with significantly lower incidence of temporary neurological complications, earlier extubation, shorter ICU-stay, and hospitalization.