深低温停循环选择性脑灌注在DeBakeyⅠ型主动脉夹层治疗中的应用

目的总结应用深低温停循环（DHCA）、选择性脑灌注（SCP）在DeBakeyⅠ型主动脉夹层治疗中的方法和经验。方法2004年11月-2008年10月,在深低温停循环选择性脑灌注条件下对DeBakeyⅠ型主动脉夹层动脉瘤病人实施升主动脉及全弓替换＋支架＂象鼻＂手术11例,其中男9例,女2例,年龄22～59岁。结果所有病人无术后死亡均痊愈出院,全组平均体外循环时间（178.6±45.5）min,心肌血运阻断时间（102.6±23.5）min,选择性脑灌注时间（36.4±13.4）min。血管吻合口出血二次开胸止血1例;脑梗塞1例;经治疗后治愈。全组出院病人随访期间,无晚期死亡或需要再次手术病例。结论DeBakeyⅠ型主动脉夹层手术中应用深低温停循环、选择性脑灌注可成功保障手术安全,有效减少术后并发症。

The application of deep hypothermic circulatory arrest and selective cerebral perfusion in the surgical treatment of DeBakey type Ⅰ aortic dissection

Objective To summarize the methods and the experiences of deep hypothermia circulatory arrest （DHCA） and selective cerebral perfusion（SCP） in the surgical treatment of DeBakey type Ⅰ aortic dissection.Methods From November 2004 to October 2008, 11 consecutive patients with DeBakey type Ⅰ aortic dissection underwent the procedure of total aortic arch replacement eombined with stented elephant trunk implantation（9 mele,2 femele）,with an age range of 22-59 years old .Deep hypothermia circulatory arrest （DHCA） and selective cerebral perfusion（SCP） were used in all patients.The clinical data were retrospectively analyzed.Results There was no postoperative death and all patients were discharged from hospital.Average cardiopulmonary bypass time was（178.6±45.5）minutes,average aortic cross clamp time was（102.6±23.5）min and average selective cerebral perfusion and lower body arrest time was（36.4±13.4） minutes. One patient had cerebral infarction secondary to embolism.There was no late death during follow up.Conclusion It is safe to apply the selected cerebral perfusion during ascending aorta and total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta.selective cerebral protection （SCP）are useful for decrease postoperative complications.