上海医学
上海醫學
상해의학
SHANGHAI MEDICAL JOURNAL
2009年
11期
956-958
,共3页
陈杰%李玮伟%周懿之%王祥瑞
陳傑%李瑋偉%週懿之%王祥瑞
진걸%리위위%주의지%왕상서
深低温停循环%选择性脑灌注%并发症%神经系统
深低溫停循環%選擇性腦灌註%併髮癥%神經繫統
심저온정순배%선택성뇌관주%병발증%신경계통
Deep hypothermic circulatory arrest%Selective cerebral perfusion%Complications%Nervous system
目的 探讨深低温停循环术(DHCA)联合经右锁骨下动脉行选择性脑灌注术对降低手术患者术后神经系统并发症的有效性.方法 选择应用DHCA的患者45例,分为单纯组(单纯行DHCA,29例)和联合组(行DHCA联合选择性脑灌注,16例).分析围术期处理方法与术后神经系统并发症的关系.结果 单纯组、联合组的最长停循环时间分别为37、55 min;联合组停循环时间超过30 min的患者有6例(37.5%),显著多于单纯组(2例,6.9%,P<0.05);而两组间停循环时间、体外循环时间、辅助循环时间、复温时间以及最低鼻咽温的差异均无统计学意义(P值均>0.05).单纯组的神经系统并发症发生率为13.8%(4/29),其中2例偏瘫,1例失语,1例昏睡;联合组的神经系统并发症发生率为6.3%(1/16),1例失语;两组间神经系统并发症发生率的差异无统计学意义(P>0.05).结论 在确保深低温(15～18℃),限制停循环时间<60 min时,DHCA联合经右锁骨下动脉行选择性脑灌注术能安全用于需暂停循环时间较长的手术.
目的 探討深低溫停循環術(DHCA)聯閤經右鎖骨下動脈行選擇性腦灌註術對降低手術患者術後神經繫統併髮癥的有效性.方法 選擇應用DHCA的患者45例,分為單純組(單純行DHCA,29例)和聯閤組(行DHCA聯閤選擇性腦灌註,16例).分析圍術期處理方法與術後神經繫統併髮癥的關繫.結果 單純組、聯閤組的最長停循環時間分彆為37、55 min;聯閤組停循環時間超過30 min的患者有6例(37.5%),顯著多于單純組(2例,6.9%,P<0.05);而兩組間停循環時間、體外循環時間、輔助循環時間、複溫時間以及最低鼻嚥溫的差異均無統計學意義(P值均>0.05).單純組的神經繫統併髮癥髮生率為13.8%(4/29),其中2例偏癱,1例失語,1例昏睡;聯閤組的神經繫統併髮癥髮生率為6.3%(1/16),1例失語;兩組間神經繫統併髮癥髮生率的差異無統計學意義(P>0.05).結論 在確保深低溫(15～18℃),限製停循環時間<60 min時,DHCA聯閤經右鎖骨下動脈行選擇性腦灌註術能安全用于需暫停循環時間較長的手術.
목적 탐토심저온정순배술(DHCA)연합경우쇄골하동맥행선택성뇌관주술대강저수술환자술후신경계통병발증적유효성.방법 선택응용DHCA적환자45례,분위단순조(단순행DHCA,29례)화연합조(행DHCA연합선택성뇌관주,16례).분석위술기처리방법여술후신경계통병발증적관계.결과 단순조、연합조적최장정순배시간분별위37、55 min;연합조정순배시간초과30 min적환자유6례(37.5%),현저다우단순조(2례,6.9%,P<0.05);이량조간정순배시간、체외순배시간、보조순배시간、복온시간이급최저비인온적차이균무통계학의의(P치균>0.05).단순조적신경계통병발증발생솔위13.8%(4/29),기중2례편탄,1례실어,1례혼수;연합조적신경계통병발증발생솔위6.3%(1/16),1례실어;량조간신경계통병발증발생솔적차이무통계학의의(P>0.05).결론 재학보심저온(15～18℃),한제정순배시간<60 min시,DHCA연합경우쇄골하동맥행선택성뇌관주술능안전용우수잠정순배시간교장적수술.
Objective To study the effectiveness of deep hypothermic circulatory arrest(DHOA)combined selective cerebral perfusion in reducing the complication of nerve system after surgery.Methods Forty-five patients undergoing DHCA were divided into two groups:DHCA group(group 1,n=29),DHCA combined with selective cerebral perfusion group(group 2,n=16).The relationship between peripheral managements and complications of nerve system after surgery was analyzed.Results The longest durations of DHCA were 37 min and 55 min in group 1 and group 2,respectively;6(37.5%)patients in group 2 and 2(6.9%)in group 1 had a duration of DHCA for more than 30 min(P<0.05).There were no significant differences in the mean duration of DHCA,mean period of cardiopulmonary bypass,duration of assisted circulation,temperature recover time,and the lowest nasopharyngeal temperature between the two groups(P>0.05).The complication rates of nervous system were 13.8% in group 1(hemiplegia 2,aphasia 1,drowsiness 1;group 1:aphasia 1)and 6.3% in group 2(aphasia),and there was no significant difference between the 2 groups(P>0.05).Conclusion If the deep hypothermia is controlled at 15-18℃ and duration of DHCA is<60 min,DHCA combined with selective cerebral perfusion is safe for the surgery needing longer duration of DHCA.
