应用孙式手术治疗主动脉夹层的体外循环管理策略

目的回顾Stanford A型主动脉夹层行孙式手术外科治疗的体外循环(ECC)管理方法,总结深低温停循环(DH-CA)过程中的器官保护方法,以减少术后并发症的发生。方法 2009年2月至2009年12月,对我院108例Stanford A型主动脉夹层患者行孙式手术,均采用DHCA选择性顺行脑灌注(SACP)方法,脑灌注流量5～10 ml/(kg.min)。心肌保护均采用血液停搏液。术中采用洗血球机以及ECC中应用超滤技术。结果平均ECC时间(189±48)min,平均心肌阻断时间(98±27)min,ASCP时间(21±5)min。DHCA时鼻温/直肠温(19.8±1.5)℃/(23.4±2.5)℃,降温时间(38±10)min,复温时间(91±16)min。气管插管时间7～450(48±68)h,ICU时间10～455(60±71)h。院内死亡4例(3.7%)。结论针对Stanford A型主动脉夹层行孙式手术,采用合理的ECC管理方法可以得到满意的临床结果,有效减少术后死亡率和并发症的发生率。

Strategy of cardiopulmonary bypass for Stanford Type A aortic dissection with using SUN's procedure

OBJECTIVE To summarize the strategy of cardiopulmonary bypass（CPB） for Stanford type A aortic dissection with using SUN＇s procedure.METHODS From February to December in 2009,one hundred and eight patients of Stanford type A aortic dissection underwent SUN＇s procedure with deep hypothermic circulatroy arrest（DHCA） and selective antegrade cerebral perfusion（SACP）.The flow rate of SACP was maintained with 5～10 ml/（kg·min） during DHCA.Myocardial protection was established with cold blood cardioplegia.We used cell saver and ultrafiltration during the operation.RESULTS Mean CPB time was 189±48 min,and mean aortic clamp time was 98±27 min.Mean duration of SACP was 21±5 min.Temperature of nasopharynx was decreased to 19.8±1.5℃,temperature of rectum was controlled at 23.4±2.5℃.The average cooling and rewarming time was（38±10） min and（91±30） min.Intubation time in intensive care unit（ICU） was 7～450 hours（48±68h）;mean ICU stay time was 10～455 hours（60±71h）.Hospital mortality in this group was 3.7%（4/108）.CONCLUSION Using suitable management of CPB could obtain satisfactory clinical survival rate in patients of Stanford type A aortic dissection undergoing SUN＇s procedure.Also,these important organ protection methods are also useful to decrease the complications.