中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2012年
7期
409-411
,共3页
胡琳%孙图成%蒋雄刚%王旸%陈剑锋
鬍琳%孫圖成%蔣雄剛%王旸%陳劍鋒
호림%손도성%장웅강%왕양%진검봉
主动脉夹层%顺行性脑灌注%中枢神经系统并发症
主動脈夾層%順行性腦灌註%中樞神經繫統併髮癥
주동맥협층%순행성뇌관주%중추신경계통병발증
Aortic dissection%Antegrade cerebral perfusion%Neurological complications
目的 探讨A型急性主动脉夹层弓部手术中顺行脑灌注的不同流量管理方法对患者术后中枢神经系统并发症的影响.方法 对我科2007年3月至2011年11月189例A型急性主动脉夹层患者弓部手术的临床资料进行回顾性分析,根据顺行性脑灌注流量的不同管理方法分为A、B两组.A组96例采用单泵双管进行下半身和脑部同时灌注,灌注流量自然分配；B组93例在连接脑灌注的动脉供血管上加装一个离心泵电磁流量传感器探头,精确监控脑灌注的流量(10 ml· kg-1·min-1).比较两组患者术后中枢神经系统并发症发生率.结果 两组体外循环时间、升主动脉阻断时间及停循环时间的组间差异无统计学意义(P＞0.05).A组术后中枢神经系统并发症发生率5.2％,B组1.1％,B组明显低于A组,差异有统计学意义(P＜0.05).结论 主动脉弓部手术行顺行性脑灌注时,精确控制其流量能有效降低术后中枢神经系统并发症.
目的 探討A型急性主動脈夾層弓部手術中順行腦灌註的不同流量管理方法對患者術後中樞神經繫統併髮癥的影響.方法 對我科2007年3月至2011年11月189例A型急性主動脈夾層患者弓部手術的臨床資料進行迴顧性分析,根據順行性腦灌註流量的不同管理方法分為A、B兩組.A組96例採用單泵雙管進行下半身和腦部同時灌註,灌註流量自然分配；B組93例在連接腦灌註的動脈供血管上加裝一箇離心泵電磁流量傳感器探頭,精確鑑控腦灌註的流量(10 ml· kg-1·min-1).比較兩組患者術後中樞神經繫統併髮癥髮生率.結果 兩組體外循環時間、升主動脈阻斷時間及停循環時間的組間差異無統計學意義(P＞0.05).A組術後中樞神經繫統併髮癥髮生率5.2％,B組1.1％,B組明顯低于A組,差異有統計學意義(P＜0.05).結論 主動脈弓部手術行順行性腦灌註時,精確控製其流量能有效降低術後中樞神經繫統併髮癥.
목적 탐토A형급성주동맥협층궁부수술중순행뇌관주적불동류량관리방법대환자술후중추신경계통병발증적영향.방법 대아과2007년3월지2011년11월189례A형급성주동맥협층환자궁부수술적림상자료진행회고성분석,근거순행성뇌관주류량적불동관리방법분위A、B량조.A조96례채용단빙쌍관진행하반신화뇌부동시관주,관주류량자연분배；B조93례재련접뇌관주적동맥공혈관상가장일개리심빙전자류량전감기탐두,정학감공뇌관주적류량(10 ml· kg-1·min-1).비교량조환자술후중추신경계통병발증발생솔.결과 량조체외순배시간、승주동맥조단시간급정순배시간적조간차이무통계학의의(P＞0.05).A조술후중추신경계통병발증발생솔5.2％,B조1.1％,B조명현저우A조,차이유통계학의의(P＜0.05).결론 주동맥궁부수술행순행성뇌관주시,정학공제기류량능유효강저술후중추신경계통병발증.
Objective To investigate the effect of flow management of cerebral perfusion during aortic arch surgery on the neurological complication.Methods From March 2007 to November 2011,189 patients underwent aortic arch surgery with hypothermic circulatory arrest plus antegrade cerebral perfusion in our department.The clinical data were analyzed retrospectively.According to the different methods of cerebral perfusion flow nanagement,patients were divided into two groups.Single pump with double limb (to the lower body and brain) perfusion was used in group A (96 patients),based on natural distribution of petfusion flow without control.Modified flow management was used in group B (93 patients).A magnetic flow sensor probes was installed on the brain perfusion limb to monitor and control the cerebral perfusion flow precisely (10 ml · kg-1 · min-1).Postoperative neurological complications were compared between two groups.Results There was no significant difference between the two groups in CPB time,aortic clamping time and circulatory arreating time.However,the morbidity of postoperative neurological complications in group B was much lower than that in group A (1.1％ vs 5.2％,P ＜0.05).Conclusion When performing antegrade cerebral perfusion during aortic arch surgery,precisely control of cerebral perfusion flow can reduce the morbidity of postoperative neurological complications effectively.
