胸腹主动脉瘤开放修复术中的主动降温可改善预后。
Active cooling during open repair of thoraco-abdominal aortic aneurysms improves outcome.
作者信息
von Segesser L K, Marty B, Mueller X, Ruchat P, Gersbach P, Stumpe F, Fischer A
机构信息
Department for Cardiovascular Surgery, University Hospital Vaudois, CHUV, Lausanne, Switzerland.
出版信息
Eur J Cardiothorac Surg. 2001 Apr;19(4):411-5; discussion 415-6. doi: 10.1016/s1010-7940(01)00628-5.
OBJECTIVE
Evaluate impact of active cooling with partial cardiopulmonary bypass (CPB) and low systemic heparinization during open repair of thoracoabdoninal aortic aneurysms.
METHODS
Prospective analysis of 100 consecutive patients undergoing surgical repair of thoracoabdominal aortic aneurysms. Partial CPB and normothermic (36 degrees C) or hypothermic (29 degrees C) perfusion was selected in accordance to the surgeons preference. In the hypothermic group, aortic cross clamp was applied when the target temperature of the venous blood was achieved and rewarming was started after declamping.
RESULTS
52/100 patients (62.2+/-10.9 years) received normothermic and 48/100 patients hypothermic perfusion (63.8+/-10.6 years: NS). Emergent procedures accounted for 18/52 (35%) with normothermia vs. 21/48 (44%: NS) with hypothermia. The number of aortic segments (eight = maximum including arch and bifurcation) replaced was 3.9+/-1.5 with normothermia vs. 4.1+/-1.5 with hypothermia (NS); Crawford type II aneurysms accounted for 21/52 patients (40%) for normothermia vs. 20/48 (42%:NS) for hypothermia. Total clamp time was 38+/-21 min with normothermia vs. 47+/-28 min with hypothermia (P=0.05). Pump time was 55+/-28 min with normothermia vs. 84+/-34 min with hypothermia (P=0.001). Mortality at 30 days was 8/52 patients (15%) with normothermia vs. 2/48 (4%) with hypothermia (P=0.06; odds ratio = 4.1). Parapareses/plegias occurred in 4/52 patients (8%) with normothermia vs. 4/48 (8%) with hypothermia (NS). Revisions for bleeding were required in 4/52 patients (8%) with normothermia vs. 2/48 patients (4%) with hypothermia (P=0.38). Revisions for distal vascular problems were necessary in 5/52 patients (10%) with normothermia vs. 2/48 (4%) with hypothermia (P=0.25). Freedom from death, paraplegia, and surgical revision was 89.9% with normothermia vs. 94.8% with hypothermia (P=0.04; odds ratio 2.0).
CONCLUSIONS
Active cooling during repair of thoracoabdominal aortic aneurysms allows for longer cross-clamp times, more complex repairs and improves outcome.
目的
评估在胸腹主动脉瘤开放修复术中使用部分体外循环（CPB）和低全身肝素化进行主动降温的影响。
方法
对100例连续接受胸腹主动脉瘤手术修复的患者进行前瞻性分析。根据外科医生的偏好选择部分CPB和常温（36℃）或低温（29℃）灌注。在低温组中，当静脉血达到目标温度时应用主动脉交叉钳夹，并在松开钳夹后开始复温。
结果
52/100例患者（62.2±10.9岁）接受常温灌注，48/100例患者接受低温灌注（63.8±10.6岁：无显著性差异）。急诊手术在常温组中占18/52（35%），在低温组中占21/48（44%：无显著性差异）。置换的主动脉节段数量（最多8个，包括弓部和分叉部）常温组为3.9±1.5个，低温组为4.1±1.5个（无显著性差异）；Crawford II型动脉瘤在常温组中占21/52例患者（40%），在低温组中占20/48例患者（42%：无显著性差异）。总钳夹时间常温组为38±21分钟，低温组为47±28分钟（P=0.05）。泵血时间常温组为55±28分钟，低温组为84±34分钟（P=0.001）。30天死亡率常温组为8/52例患者（15%），低温组为2/48例患者（4%）（P=0.06；优势比=4.1）。截瘫/偏瘫在常温组中发生于4/52例患者（8%），在低温组中发生于4/48例患者（8%）（无显著性差异）。常温组有4/52例患者（8%）因出血需要再次手术，低温组有2/48例患者（4%）（P=0.38）。常温组有5/52例患者（10%）因远端血管问题需要再次手术，低温组有2/48例患者（4%）（P=0.25）。常温组免于死亡、截瘫和再次手术的比例为89.9%，低温组为94.8%（P=0.04；优势比2.0）。
结论
胸腹主动脉瘤修复术中的主动降温可延长交叉钳夹时间，进行更复杂的修复并改善预后。
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