Takano H, Sakakibara T, Matsuwaka R, Hori T, Sakagoshi N, Shinohara N
Department of Cardiovascular Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennoji-ku, 543-0035, Osaka, Japan.
Eur J Cardiothorac Surg. 2000 Sep;18(3):262-9. doi: 10.1016/s1010-7940(00)00516-9.
To determine the safety and usefulness of antegrade hypothermic cerebral perfusion in conjunction with mild hypothermic (tepid) visceral perfusion (so-called cool head-warm body perfusion; CHWB) in aortic surgery; the clinical outcomes and perioperative data on this new technique were retrospectively analyzed.
From January 1990 to March 1999, 59 patients underwent ascending aorta or aortic arch surgery using antegrade selective cerebral perfusion (SCP). Three perfusion techniques, differentiated by perfusion temperature, were used, those being deep hypothermia (DH; nasopharyngeal temperature of 20 degrees C, n=14), moderate hypothermia (MH; nasopharyngeal temperature of 28 degrees C, n=17) and CHWB (nasopharyngeal temperature of 25 degrees C and bladder temperature of 32 degrees C, n=28). Selection of the technique largely followed a chronological pattern, in this order: DH, MH and, more recently, CHWB. The three groups were retrospectively compared in terms of operative outcome, duration of cardiopulmonary bypass (CPB) and operation, and intraoperative blood loss.
The early (within 30 days after surgery) mortality/hospital mortality (including operative mortality) was 7.1/21.4, 5.9/11.8 and 3.6/7.1% in the DH, MH and CHWB groups, respectively. The rate of stroke was 7.1, 6.3 and 3.6% in the DH, MH and CHWB groups, respectively. No statistical difference was found in early or hospital mortality, or in the rate of stroke among the three groups. The CPB time, especially the time for rewarming, was significantly shorter in the CHWB than in the DH group. Likewise, the operation time, especially the time after CPB, was significantly shorter in the CHWB than in the DH and MH groups. Blood loss was significantly less in the CHWB than in the DH group.
Our data suggest that CHWB perfusion in aortic surgery is a safe and useful technique in shortening the operation time and reducing blood loss, but further prospective study is necessary.
确定在主动脉手术中，顺行性低温脑灌注联合轻度低温（微温）内脏灌注（即所谓的“冷头暖体灌注”；CHWB）的安全性和有效性；对这项新技术的临床结果和围手术期数据进行回顾性分析。
1990年1月至1999年3月，59例患者接受了升主动脉或主动脉弓手术，采用顺行性选择性脑灌注（SCP）。使用了三种根据灌注温度区分的灌注技术，即深度低温（DH；鼻咽温度20℃，n = 14）、中度低温（MH；鼻咽温度28℃，n = 17）和CHWB（鼻咽温度25℃，膀胱温度32℃，n = 28）。技术的选择在很大程度上遵循时间顺序，依次为：DH、MH，以及最近的CHWB。对三组在手术结果、体外循环（CPB）时间和手术时间以及术中失血方面进行回顾性比较。
DH、MH和CHWB组的早期（术后30天内）死亡率/住院死亡率（包括手术死亡率）分别为7.1/21.4%、5.9/11.8%和3.6/7.1%。三组的中风发生率分别为7.1%、6.3%和3.6%。三组在早期或住院死亡率以及中风发生率方面未发现统计学差异。CHWB组的CPB时间，尤其是复温时间，明显短于DH组。同样，CHWB组的手术时间，尤其是CPB后的时间，明显短于DH组和MH组。CHWB组的失血量明显少于DH组。
我们的数据表明，主动脉手术中的CHWB灌注是一种安全且有用的技术，可缩短手术时间并减少失血，但有必要进行进一步的前瞻性研究。
