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[应用深低温体外循环并间歇性循环阻断技术治疗胸腹主动脉瘤的手术临床结果]

[Clinical outcome of the operation using deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest in thoracoabdominal aortic aneurysm].

作者信息

Kashikie H, Nakamura K, Oda T, Imada T

机构信息

Department of Cardiovascular Surgery, Cardio Vascular Center, Omura Municipal Hospital, Omura, Japan.

出版信息

Kyobu Geka. 2004 Apr;57(4):295-9.

Abstract

Deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest has been used for protection of the spinal cord during operations for thoracoabdominal aortic aneurysm (TAAA) in our hospital. We examined the effect of this adjunct this time. We studied 15 patients who were operated using deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest among 19 patients with the TAAA who we performed the operations from 1995 through 2003. The patients ranged in age from 21 to 80 (an average of 65 +/- 14 SD) years. We used deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest between 16 and 20 degrees C for the adjunct but did not use a monitor of evoked spinal cord potentials or cerebrospinal fluid drainage. Operation time was an average of 805 +/- 168 minutes. Cardiopulmonary bypass time was an average of 403 +/- 73 minutes. Deep hypothermic cardiopulmonary bypass time was an average of 215 +/- 67.5 SD minutes. Duration of spinal cord ischemia to the intercostal arteries were reconstructed was from 25 to 104 (50.5 +/- 24) minutes. We recognized nerve disorder in 6 cases in progress after operation, and respiratory organs management period and a hospitalization period became long, but the hospitalization death was 3 cases, and, as for the paraplegia was no case, 12 patients were discharged in good condition. The deep hypothermic cardiopulmonary bypass with intervals of circulatory arrest was regarded as a useful adjunct for prevention of the paraplegia.

摘要

在我院,伴有循环阻断间隔的深度低温体外循环已被用于胸腹主动脉瘤(TAAA)手术期间的脊髓保护。此次我们研究了这种辅助手段的效果。我们对1995年至2003年间接受手术的19例TAAA患者中的15例进行了伴有循环阻断间隔的深度低温体外循环手术。患者年龄在21岁至80岁之间(平均65±14标准差)。我们使用16至20摄氏度伴有循环阻断间隔的深度低温体外循环作为辅助手段,但未使用脊髓诱发电位监测仪或脑脊液引流。手术时间平均为805±168分钟。体外循环时间平均为403±73分钟。深度低温体外循环时间平均为215±67.5标准差分钟。至肋间动脉重建时脊髓缺血的持续时间为25至104(50.5±24)分钟。我们发现术后有6例出现神经功能障碍,呼吸器官管理期和住院时间延长,但住院死亡3例,无一例发生截瘫,12例患者康复出院。伴有循环阻断间隔的深度低温体外循环被认为是预防截瘫的一种有用辅助手段。

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