Usui A, Yasuura K, Watanabe T, Maseki T
Department of Thoracic Surgery, Nagoya University School of Medicine, Japan.
Eur J Cardiothorac Surg. 1999 May;15(5):571-8. doi: 10.1016/s1010-7940(99)00096-2.
Selection of a brain protection method is a primary concern for aortic arch surgery. We performed a retrospective study to compare the respective advantages and disadvantages of retrograde cerebral perfusion (RCP) and selective cerebral perfusion (SCP) in patients who underwent surgery for acute type A aortic dissection.
The study reviewed 166 patients who underwent surgery at Nagoya University or its eight branch hospitals between January 1990 and August 1996. There were 91 patients who received SCP and 75 patients who underwent RCP. Results for these two groups were compared.
There were no significant differences in age, gender, Marfan syndrome rate, DeBakey classification, or emergency operation rate. Rates of various preoperative complications were similar except for aortic valve regurgitation. Arch replacement was performed more often in SCP than in RCP patients (49% vs. 27%, P = 0.0028). There were no significant differences between groups in cardiac ischemic time or visceral organ ischemic time. However, RCP group showed shorter cardio-pulmonary bypass time (297+/-99 vs. 269+/-112 min, P = 0.013) and lower the lowest core temperature (21.6+/-3.1 degrees C vs. 18.7+/-2.1 degrees C, P = 0.0001). SCP duration was longer than RCP duration (103+/-56 vs. 54+/-24 min, P < 0.0001). Despite these differences, RCP patients were not significantly different from SCP patients with regard to any postoperative complication, neurological dysfunction (16 vs. 19%), or operative mortality (all deaths within the hospitalization; 24 vs. 21%). Regarding neurologic dysfunction, there were six cases of coma, six of motor paralysis, two of paraplegia and one of visual loss among SCP patients, and eight cases of coma, three of motor paralysis, and three of convulsion in the RCP group. The incidence of motor paralysis was higher in the SCP group, while the incidence of coma was higher in the RCP group.
RCP can be performed without clamping or cannulation of the cervical arteries, which is an advantage in reducing the chances of arterial injury or cerebral embolization. RCP is comparable to SCP in terms of clinical outcome.
选择一种脑保护方法是主动脉弓手术首要关注的问题。我们进行了一项回顾性研究，以比较逆行脑灌注（RCP）和选择性脑灌注（SCP）在急性A型主动脉夹层手术患者中的各自优缺点。
该研究回顾了1990年1月至1996年8月在名古屋大学及其八家分院接受手术的166例患者。其中91例接受SCP，75例接受RCP。比较这两组的结果。
两组在年龄、性别、马凡综合征发生率、德巴基分类或急诊手术率方面无显著差异。除主动脉瓣反流外，各种术前并发症的发生率相似。SCP组进行主动脉弓置换的频率高于RCP组（49%对27%，P = 0.0028）。两组在心脏缺血时间或内脏器官缺血时间方面无显著差异。然而，RCP组的体外循环时间较短（297±99对269±112分钟，P = 0.013），最低核心温度较低（21.6±3.1℃对18.7±2.1℃，P = 0.0001）。SCP持续时间长于RCP持续时间（103±56对54±24分钟，P < 0.0001）。尽管存在这些差异，但RCP组患者在任何术后并发症、神经功能障碍（16%对19%）或手术死亡率（住院期间所有死亡；24%对21%）方面与SCP组患者无显著差异。关于神经功能障碍，SCP组中有6例昏迷、6例运动麻痹、2例截瘫和1例视力丧失，RCP组中有8例昏迷、3例运动麻痹和3例抽搐。SCP组运动麻痹的发生率较高，而RCP组昏迷的发生率较高。
RCP无需夹闭或插管颈总动脉即可进行，这在减少动脉损伤或脑栓塞的机会方面具有优势。RCP在临床结果方面与SCP相当。
