选择性脑灌注在小儿主动脉弓手术中的应用

目的为了减轻手术中的脑损伤，探讨选择性脑灌注（SCP）技术在小儿主动脉弓手术中应用的有效性和安全性。方法2007年4月至2008年5月上海儿童医学中心对32例小儿先天性心脏病患者施行主动脉弓手术中应用SCP技术；年龄8d～103个月（14．4±25．4个月），体重2．7～22．0kg（6．7±4．4kg），其中主动脉缩窄伴心内畸形22例，主动脉弓中断伴心内畸形10例。采用弹簧动脉插管，在升主动脉靠近无名动脉根部处插管，转流降温至肛温18～20℃，然后将动脉灌注管向上延伸插入无名动脉内进行SCP。结果SCP时间为17～121min（39．6±19．4min），流量维持在15～40ml／（kg·min）29．7±6．1ml／（kg·min）]。术后死亡4例，死亡原因为低心排血量或心律失常，均无脑损伤证据。生存28例患者在临床中均无明显神经系统并发症，术后25例患者做脑电图检查均无异常，5例新生儿患者做头颅B超和脑磁共振成像（MRI）检查未见异常。结论SCP是小儿主动脉弓手术中一种简单可行和安全有效的脑保护方法。

Application of Selective Cerebral Perfusion in Pediatric Aortic Arch Reconstruction Procedure

Objective To investigate the efficacy and safety of the application of selective cerebral perfusion （SCP） technique in pediatric aortic arch reconstruction, so as to alleviate brain injury during operation. Methods From April 2007 to May 2008, 32 children aged from 8 days to 103 months （14.4±25.4 months） and weighed from 2.7 kg to 22.0 kg （6.7 ±4.4 kg） underwent aortic arch reconstruction with selective cerebral perfusion in Shanghai Children＇s Medical Center. Twenty-two suffered from aortic coarctation with intracardiac anomaly, and 10 suffered from interrupted aortic arch with intracardiac anomaly. The arterial cannulation was achieved by placing a flexible wire wound cannula in ascending aorta close to the root part of innominate artery. The rectal temperature was about 18- 20℃. Then the cannula was moved upward into innominate artery to perform SCP. Results The time of SCP was 17-121 mins（39.6±19.4 mins）, perfusion blood flow maintained in 15-40 ml/（kg · min）29.7±6.1 ml/（kg · min）]. Four cases died of low cardiac output syndrome or arrhythmia, and no evidence of brain injury was observed. No obvious neurologic complication was observed in 28 survivls. No abnormal electroencephalogram was observed in 25 cases. The results of head B sonography and brain magnetic resonance image （MRI） were normal in 5 neonates. Conclusion Selective cerebral perfusion is a simple, feasible, safe and effective technique in pediatric aortic arch reconstruction.