CAJ | 학술논문

目的探讨单、双侧顺行脑灌注在主动脉病变深低温停循环手术中的脑保护效果.方法 60例主动脉病变行深低温停循环手术病人随机分成顺行脑灌注单侧组和舣侧组,每组30例.于体外循环开始时(T_1)、停循环时(T_2)、脑灌注25 min时(T_3)、脑灌注结束时(T_4)、体外循环结束时(T_5)以及术后1 h(T_6)、6 h(T_7)、24 h(T_8)时抽取右侧颈静脉球鄙血液,采用双抗体夹心ELISA法测定血清中S-100β蛋白和神经元特异性烯醇化酶(NSE)浓度;比较两组病人的中枢神经系统并发症的发生率及病死率.结果 T_1～T_3时间点曲组间S-100β和NSE浓度差异无统计学意义,T_4～T_8时间点差异均有统计学意义.单侧组中楸神经功能障碍发生率明显较舣侧组高(33.33%对10.00%,P=0.028),两组病死率差异无统计学意义(3.33%对6.66%,P=1.000).结论在主动脉病变深低温停循环手术中,停循环25 min内单、舣侧顺行脑灌注效果相当,但超过25 min,双侧顺行腑灌注脑保护效果更佳.
목적 탐토단、쌍측순행뇌관주재주동맥병변심저온정순배수술중적뇌보호효과.방법 60례주동맥병변행심저온정순배수술병인수궤분성순행뇌관주단측조화의측조,매조30례.우체외순배개시시(T_1)、정순배시(T_2)、뇌관주25 min시(T_3)、뇌관주결속시(T_4)、체외순배결속시(T_5)이급술후1 h(T_6)、6 h(T_7)、24 h(T_8)시추취우측경정맥구비혈액,채용쌍항체협심ELISA법측정혈청중S-100β단백화신경원특이성희순화매(NSE)농도;비교량조병인적중추신경계통병발증적발생솔급병사솔.결과 T_1～T_3시간점곡조간S-100β화NSE농도차이무통계학의의,T_4～T_8시간점차이균유통계학의의.단측조중추신경공능장애발생솔명현교의측조고(33.33%대10.00%,P=0.028),량조병사솔차이무통계학의의(3.33%대6.66%,P=1.000).결론 재주동맥병변심저온정순배수술중,정순배25 min내단、의측순행뇌관주효과상당,단초과25 min,쌍측순행부관주뇌보호효과경가.
Objective To study the applicability of unilateral and bilateral antegrade cerebral perfusion during deep hy-potbermia circulatory arrest (DHCT) surgery and to determine a better method of brain protection. Methods 60 patients un-derwent aortic arch surgery were random divided into either unilateral cerebral perfusion group with a cannula in the innominate artery (n = 30 ) , or bilateral cerebral peffusion gToup with an additional cannula in the left carotid artery ( n = 30 ). S-100β,neuron specific enolase (NSE) were assayed at the following time points: the beginning of cardiopulmonary bypass (T_1), the beginning of circulatory arrcst( T_2 ), antegradc cerebral perfusion (ACP) 25 min( T_3 ), the end of ACP( T_4 ), the end of car-diopulmonary bypass ( T_5 ) , 1h( T_6 ) , 6h ( T_7 ) and 24h( T_8 ) after operation. Neurological deficit incidence and mortality were also obtained. Results There is no statistical significance for S-100β and NSE plasma concentration among time points of T_1、T_2 and T_3. But every time point among T_4、T_5、T_6、T_7 ,Ts do have statistical significances. The incidence of central nervous system dysfunction in group unilateral ACP was higher than that in group bilateral ACP ( 33.33% vs. 10.00%, P = 0.028 ).But there is no significant difference between the two groups in mortality( 3.33% vs. 6.66% ,P = 1. 000 ). Conclusion There is no significant difference between unilateral ACP and bilateral ACP in 25 min during DHCA. But as the DHCA time extends, the effect of bilateral ACP will be better.