Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
J Korean Med Sci. 2009 Oct;24(5):807-11. doi: 10.3346/jkms.2009.24.5.807. Epub 2009 Sep 23.
Although unilateral antegrade selective cerebral perfusion (UASCP) is considered a safe cerebral protection strategy during aortic surgery, an optimum temperature remains to be defined. This study compared outcomes in patients undergoing UASCP at either <24 or > or =24. Between 2000 and 2007, 104 consecutive patients underwent aortic surgery using UASCP. Patients were divided into two groups according to systemic temperature: group A comprised 64 patients undergoing deep hypothermia (<24); and group B comprised 40 patients undergoing moderate hypothermia (> or =24). Both groups were similar in terms of the extent of aortic replacement and mean UASCP time. The total cardiopulmonary bypass time and aortic cross clamp time were longer in group A. Both groups were similar in terms of 30-day mortality rate (9.4% group A, 10.0% group B), and in terms of temporary (6.7% group A, 7.7% group B) and permanent (11.3% group A, 2.6% group B) neurological deficits. Multivariate analysis showed preoperative shock status was a risk factor for in-hospital mortality, and a preoperative history of a cerebral incident was a risk factor for permanent neurological deficit. UASCP under moderate hypothermia is a relatively safe and effective cerebral protective strategy during aortic surgery.
虽然在主动脉手术中使用单侧顺行选择性脑灌注（UASCP）被认为是一种安全的脑保护策略，但仍需要确定最佳温度。本研究比较了在 UASCP 下接受 <24 或 >或 =24 温度的患者的结局。2000 年至 2007 年间，104 例连续患者接受 UASCP 主动脉手术。根据全身温度将患者分为两组：A 组 64 例患者接受深低温（<24）；B 组 40 例患者接受中度低温（>或 =24）。两组在主动脉置换程度和平均 UASCP 时间方面相似。A 组的总体外循环时间和主动脉阻断时间较长。两组在 30 天死亡率（9.4%组 A，10.0%组 B）以及临时（6.7%组 A，7.7%组 B）和永久性（11.3%组 A，2.6%组 B）神经功能缺损方面相似。多变量分析显示，术前休克状态是住院死亡率的危险因素，而术前有脑事件史是永久性神经功能缺损的危险因素。在主动脉手术中，中度低温下的 UASCP 是一种相对安全有效的脑保护策略。
