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
2014年
6期
338-341
,共4页
主动脉%动脉瘤,夹层%心脏外科手术%脑保护%灌注流量%深低温停循环%选择性脑灌注
主動脈%動脈瘤,夾層%心髒外科手術%腦保護%灌註流量%深低溫停循環%選擇性腦灌註
주동맥%동맥류,협층%심장외과수술%뇌보호%관주류량%심저온정순배%선택성뇌관주
Aorta%Aneurysm,dissection%Cardiac surgical procedures%Cerebral protection%Perfusion flow%Deep hypothermic circulatory arrest%Antegrade selective cerebral perfusion
目的 探讨急性Stanford A型主动脉夹层(acute Stanford type A aortic dissection,AAAD)手术中的合理灌注流量.方法 40例手术患者采用随机数字表法分为传统灌注流量(A)组和改良灌注流量(B)组.监测两组患者麻醉诱导结束后(Tl),最低温时(T2),以5ml· kg-1·min-1流量选择性脑灌注时(T3),恢复全身循环3 min时(T4),复温10 min(T5)和心肺转流(CPB)结束后30 min(T6)6个时点大脑中动脉的脑血流速度(Vm)及脑组织氧合指数(TOI).检测麻醉诱导后(T1)、复温后10 min(T5)、停CPB后30 min(T6)、术后6 h(T7)、术后12h(T8)和术后24 h(T9)的血浆S100蛋白浓度(ng/L)及血乳酸.结果 恢复全身循环3 min时(T4),双侧大脑中动脉的Vm,A组Vm明显高于B组[左侧:(45.46±8.57) cm/s对(28.72±9.48) cm/s,P＜0.001;右侧:(42.68±6.59) cm/s对(30.94± 11.09)cm/s,P＜0.001].此时点的A组Vm也明显高于其他时间点;T6时点,A组左侧Vm明显低于B组[(29.91±4.64) cm/s对(37.21±6.53) cm/s,P＜0.05].两组各时间点TOI均在60％以上,无显著降低者(TOI ＜35％).A组S100蛋白T6、T7、T8时点均高于B组,P＜0.05;血乳酸T6时点,高于B组[(4.88± 1.62) mmol/L对(3.82± 1.48) mmol/L],P＜ 0.05.A组患者清醒时间较B组长[(7.36±2.86)h对(5.27±3.11) h],P＜0.05.复温时间两组间差异无统计学意义[(74.40±18.50)min对(80.21±21.34) min].结论 与传统灌注流量相比,改良灌注流量既可以提供充分脑灌注,又可防止脑过度灌注.
目的 探討急性Stanford A型主動脈夾層(acute Stanford type A aortic dissection,AAAD)手術中的閤理灌註流量.方法 40例手術患者採用隨機數字錶法分為傳統灌註流量(A)組和改良灌註流量(B)組.鑑測兩組患者痳醉誘導結束後(Tl),最低溫時(T2),以5ml· kg-1·min-1流量選擇性腦灌註時(T3),恢複全身循環3 min時(T4),複溫10 min(T5)和心肺轉流(CPB)結束後30 min(T6)6箇時點大腦中動脈的腦血流速度(Vm)及腦組織氧閤指數(TOI).檢測痳醉誘導後(T1)、複溫後10 min(T5)、停CPB後30 min(T6)、術後6 h(T7)、術後12h(T8)和術後24 h(T9)的血漿S100蛋白濃度(ng/L)及血乳痠.結果 恢複全身循環3 min時(T4),雙側大腦中動脈的Vm,A組Vm明顯高于B組[左側:(45.46±8.57) cm/s對(28.72±9.48) cm/s,P＜0.001;右側:(42.68±6.59) cm/s對(30.94± 11.09)cm/s,P＜0.001].此時點的A組Vm也明顯高于其他時間點;T6時點,A組左側Vm明顯低于B組[(29.91±4.64) cm/s對(37.21±6.53) cm/s,P＜0.05].兩組各時間點TOI均在60％以上,無顯著降低者(TOI ＜35％).A組S100蛋白T6、T7、T8時點均高于B組,P＜0.05;血乳痠T6時點,高于B組[(4.88± 1.62) mmol/L對(3.82± 1.48) mmol/L],P＜ 0.05.A組患者清醒時間較B組長[(7.36±2.86)h對(5.27±3.11) h],P＜0.05.複溫時間兩組間差異無統計學意義[(74.40±18.50)min對(80.21±21.34) min].結論 與傳統灌註流量相比,改良灌註流量既可以提供充分腦灌註,又可防止腦過度灌註.
목적 탐토급성Stanford A형주동맥협층(acute Stanford type A aortic dissection,AAAD)수술중적합리관주류량.방법 40례수술환자채용수궤수자표법분위전통관주류량(A)조화개량관주류량(B)조.감측량조환자마취유도결속후(Tl),최저온시(T2),이5ml· kg-1·min-1류량선택성뇌관주시(T3),회복전신순배3 min시(T4),복온10 min(T5)화심폐전류(CPB)결속후30 min(T6)6개시점대뇌중동맥적뇌혈류속도(Vm)급뇌조직양합지수(TOI).검측마취유도후(T1)、복온후10 min(T5)、정CPB후30 min(T6)、술후6 h(T7)、술후12h(T8)화술후24 h(T9)적혈장S100단백농도(ng/L)급혈유산.결과 회복전신순배3 min시(T4),쌍측대뇌중동맥적Vm,A조Vm명현고우B조[좌측:(45.46±8.57) cm/s대(28.72±9.48) cm/s,P＜0.001;우측:(42.68±6.59) cm/s대(30.94± 11.09)cm/s,P＜0.001].차시점적A조Vm야명현고우기타시간점;T6시점,A조좌측Vm명현저우B조[(29.91±4.64) cm/s대(37.21±6.53) cm/s,P＜0.05].량조각시간점TOI균재60％이상,무현저강저자(TOI ＜35％).A조S100단백T6、T7、T8시점균고우B조,P＜0.05;혈유산T6시점,고우B조[(4.88± 1.62) mmol/L대(3.82± 1.48) mmol/L],P＜ 0.05.A조환자청성시간교B조장[(7.36±2.86)h대(5.27±3.11) h],P＜0.05.복온시간량조간차이무통계학의의[(74.40±18.50)min대(80.21±21.34) min].결론 여전통관주류량상비,개량관주류량기가이제공충분뇌관주,우가방지뇌과도관주.
Objective To research the reasonable perfusion flow of cardiopulmonary bypass during aortic arch procedure of patients with acute type A aortic dissection.Methods Forty patients suffered from acute Stanford type A aortic dissection had been divided into two groups randomly.Group A named traditional perfusion flow group,group B named modified perfusion flow group.Monitoring cerebral blood flow and cerebral tissue oxygen during "deep hyperthermia circulatory arrest and antegrade aelective cerebral perfusion" procedure by transcranial doppler(TCD) and near-infrared spectroscopy(NIRS).The concentration of S100 protein and lactic acid was measured at six time point.Results Statistical difference of mean blood flow velocity of MCA had been found between two group 3 min after total flow reperfusion.TOI was more tban 60％ during study in both of groups.S100 protein in group A was significantly higher than group B at T6,T7 and T8.Statistical difference of blood lactic concentration had been found between two groups,(4.88± 1.62) mmol/L in group A,(3.83± 1.48) mmol/L in group B,P ＜ 0.05.Safe consciousness time between two groups was difference,(7.36± 2.86) h in group A and (5.27± 3.11) h in group B,P ＜ 0.05.Conclusion Compared with the traditional perfusion flow,modified perfusion flow can provide sufficient cerebral perfusion and prevent the "luxury perfusion".
