Sueda T, Nomimura T, Kagawa T, Morita S, Hayashi S, Orihashi K, Shikata H, Ryuu G, Hamanaka Y, Matsuura Y
First Department of Surgery, Hiroshima University School of Medicine, Japan.
Hiroshima J Med Sci. 1992 Jun;41(2):31-5.
During the past 5 years, 30 cases of thoracic aortic aneurysm were treated. Selective cerebral perfusion (SCP) and retrograde cerebral perfusion (RCP) were conducted for cerebral protection during aortic cross clamping. SCP was carried out in 5 cases of dissecting aneurysm (all Stanford type A, including a case of AAE) and 3 cases of arch aneurysm. RCP was conducted in 5 cases of dissecting aneurysm (4 Stanford type A, 1 Stanford type B with retrograde dissection) and 2 cases of aortic arch aneurysm. The mean cerebral perfusion time of SCP exceeded that of RCP (89 +/- 26 min in SCP versus 61 +/- 33 min in RCP p < 0.05). The hospital mortality rate was 38% (SCP) and 29% (RCP). Neurological complications were prolonged unconsciousness (1/8 in SCP, 1/7 in RCP) and transient paralysis (0/8 in SCP, 1/7 in RCP). Although the mechanism for the cerebral protective effect of RCP is unknown, this perfusion method is easy and safe, requiring little time for ascending and/or arch aortic reconstruction.
在过去5年中，共治疗了30例胸主动脉瘤。在主动脉阻断期间，采用选择性脑灌注（SCP）和逆行脑灌注（RCP）进行脑保护。5例夹层动脉瘤（均为斯坦福A型，包括1例主动脉弓夹层动脉瘤）和3例弓部动脉瘤采用了SCP。5例夹层动脉瘤（4例斯坦福A型，1例伴有逆行夹层的斯坦福B型）和2例主动脉弓动脉瘤采用了RCP。SCP的平均脑灌注时间超过RCP（SCP为89±26分钟，RCP为61±33分钟，p<0.05）。医院死亡率分别为38%（SCP）和29%（RCP）。神经并发症包括昏迷时间延长（SCP组8例中有1例，RCP组7例中有1例）和短暂性瘫痪（SCP组8例中无，RCP组7例中有1例）。尽管RCP脑保护作用的机制尚不清楚，但这种灌注方法简便、安全，升主动脉和/或主动脉弓重建所需时间短。
