Kouchoukos N T, Masetti P, Rokkas C K, Murphy S F, Blackstone E H
The Heart Center, Missouri Baptist Medical Center, St. Louis, USA.
Ann Thorac Surg. 2001 Sep;72(3):699-707; discussion 707-8. doi: 10.1016/s0003-4975(01)02800-4.
Hypothermic cardiopulmonary bypass with circulatory arrest is an important adjunct for operations on the distal aortic arch and the descending thoracic and thoracoabdominal aorta. Its safety and efficacy compared with other techniques (eg, simple aortic clamping, partial cardiopulmonary bypass, and regional hypothermia) are not clearly established.
One hundred sixty-one patients (ranging from 20 to 83 years old) with descending thoracic or thoracoabdominal aortic disease had resection and graft replacement of the involved aortic segments using hypothermic cardiopulmonary bypass usually with intervals of circulatory arrest (mean interval, 38 minutes).
The 30-day mortality rate was 6.2% (10 patients). It was 41% (7 of 17) for patients having emergent operations (rupture or acute dissection) and 2.1% (3 of 144) for all other patients (p < 0.001). The 90-day mortality rate was 11.8% (19 patients). Paraplegia occurred in 4 and paraparesis in 1 of the 156 operative survivors whose lower limb function could be assessed postoperatively (3.2%). Among the 91 survivors with thoracoabdominal aortic disease, early paraplegia occurred in 1 of 33 patients with Crawford type I disease, 0 of 34 with type II disease, and 2 of 24 with type III disease. One patient (type II disease) had development of paraplegia on the tenth postoperative day. None of the 50 patients with aortic dissection experienced paralysis. Renal dialysis was required in 4 (2.5%) of the 157 operative survivors, prolonged inotropic support (> 48 hours) in 17 (11%), reoperation for bleeding in 8 (5%), mechanical ventilation (> 48 hours) in 31 (20%), and tracheostomy in 13 (8%). Three patients (1.9%) sustained a stroke.
Hypothermic cardiopulmonary bypass provides safe and substantial protection against paralysis and renal, cardiac, and visceral organ system failure that equals or exceeds that of other currently used techniques but without the need of other adjuncts.
低温体外循环合并循环停止是用于远端主动脉弓及胸降主动脉和胸腹主动脉手术的一项重要辅助手段。与其他技术（如单纯主动脉钳夹、部分体外循环和局部低温）相比，其安全性和有效性尚未明确确立。
161例年龄在20至83岁之间的胸降主动脉或胸腹主动脉疾病患者，采用低温体外循环并通常间隔循环停止（平均间隔38分钟）进行受累主动脉段的切除和移植置换术。
30天死亡率为6.2%（10例患者）。急诊手术（破裂或急性夹层）患者的死亡率为41%（17例中的7例），其他所有患者的死亡率为2.1%（144例中的3例）（p<0.001）。90天死亡率为11.8%（19例患者）。在156例术后可评估下肢功能的手术幸存者中，4例发生截瘫，1例发生轻瘫（3.2%）。在91例胸腹主动脉疾病幸存者中，33例克劳福德I型疾病患者中有1例发生早期截瘫，34例II型疾病患者中无1例发生，24例III型疾病患者中有2例发生。1例患者（II型疾病）在术后第10天发生截瘫。50例主动脉夹层患者均未发生瘫痪。157例手术幸存者中有4例（2.5%）需要进行肾透析，17例（11%）需要延长强心支持（>48小时），8例（5%）因出血需要再次手术，31例（20%）需要机械通气（>48小时），13例（8%）需要气管切开术。3例患者（1.9%）发生中风。
低温体外循环可提供安全且有效的保护，预防瘫痪以及肾脏、心脏和内脏器官系统衰竭，其效果等同于或超过目前使用的其他技术，且无需其他辅助手段。
