Numata Satoshi, Thomson Duncan S, Seah Peng, Singh Taranpreet
Department of Cardiothoracic Surgery, John Hunter Hospital, NewLambton, NSW, Australia.
Heart Lung Circ. 2009 Oct;18(5):334-6. doi: 10.1016/j.hlc.2009.03.051. Epub 2009 Aug 13.
Antegrade cerebral perfusion is one of the most reliable methods of organ protection during hypothermic circulatory arrest for aortic arch surgery. We used a simplified antegrade cerebral perfusion technique with low mortality and morbidity.
Between January 2005 and August 2008, 21 patients underwent aortic arch surgery with unilateral antegrade selective cerebral perfusion through the brachiocephalic artery and moderate hypothermic circulatory arrest. The mean age for patients was 58.0+/-11.1 (27-82) years. Cardiopulmonary bypass was commenced and the ascending aorta was cross-clamped. Patients were cooled to 22-28 degrees C, whilst the proximal anastomosis was performed. The brachiochephalic artery was cannulated using a balloon tipped 15Fr catheter used for retrograde cardioplegia. Antegrade cerebral perfusion was established at the rate of 10 ml//kg/min. The perfusion pressure was controlled between 50 and 70 mm Hg whilst the distal anastomosis was completed.
There were no operative deaths and no permanent neurological deficits. Four patients had temporary confusion. Mean antegrade cerebral perfusion time was 21.6+/-8.0 (12-48)min. Eight out of 20 patients had circulatory arrest at 28 degrees C and their mean circulatory arrest time was 22.8+/-4.7 (16-32)min.
The mortality and neurological outcomes of aortic surgery using unilateral antegrade cerebral perfusion with moderate hypothermic circulatory arrest produced satisfactory results. Bilateral cannulation and deep hypothermia appear to be unnecessary in most cases. The coagulopathy from deep hypothermia is thereby avoided.
顺行性脑灌注是主动脉弓手术低温循环停搏期间最可靠的器官保护方法之一。我们采用了一种简化的顺行性脑灌注技术，其死亡率和发病率较低。
2005年1月至2008年8月期间，21例患者接受了主动脉弓手术，通过头臂动脉进行单侧顺行性选择性脑灌注和中度低温循环停搏。患者的平均年龄为58.0±11.1（27 - 82）岁。开始进行体外循环并钳夹升主动脉。在进行近端吻合时，将患者体温降至22 - 28摄氏度。使用用于逆行心脏停搏的带气囊尖端的15Fr导管插入头臂动脉。以10 ml/kg/min的速率建立顺行性脑灌注。在完成远端吻合时，将灌注压力控制在50至70 mmHg之间。
无手术死亡病例，也无永久性神经功能缺损。4例患者出现短暂性意识模糊。平均顺行性脑灌注时间为21.6±8.0（12 - 48）分钟。20例患者中有8例在28摄氏度时出现循环停搏，其平均循环停搏时间为22.8±4.7（16 - 32）分钟。
采用单侧顺行性脑灌注和中度低温循环停搏进行主动脉手术的死亡率和神经学结果令人满意。在大多数情况下，双侧插管和深度低温似乎没有必要。从而避免了深度低温引起的凝血功能障碍。
