Department of Surgery, Section of Cardiothoracic Surgery, New York Medical College, Westchester Medical Center, Valhalla, New York, USA.
Ann Cardiothorac Surg. 2013 May;2(3):326-30. doi: 10.3978/j.issn.2225-319X.2013.03.02.
Selective antegrade cerebral perfusion (SACP) for aortic arch surgery has evolved considerably since it was first reported. Various pressure rates have been investigated through animal models, as has the effect of warmer perfusate temperatures and hematocrit. Clinical research into pH management, the role of unilateral and bilateral perfusion, and core temperatures have further refined the procedure. We recommend the following protocol for SACP: perfusion pressure between 40-60 mmHg, flow rates between 6-10 mL/kg/min, and perfusate temperature of 20-28 °C; core cooling to 18-30 °C contingent on duration of arrest; alpha-stat pH management; hematocrit between 25-30%; near infrared spectroscopy to monitor cerebral perfusion; and bilateral perfusion when prolonged durations of SACP is anticipated.
选择性顺行脑灌注 (SACP) 技术在主动脉弓手术中的应用自首次报道以来已经有了很大的发展。通过动物模型研究了各种压力速率，以及温热灌流液温度和红细胞压积的影响。对 pH 值管理、单侧和双侧灌注的作用以及核心温度的临床研究进一步完善了该手术。我们推荐以下 SACP 方案：灌注压力 40-60mmHg，流量 6-10mL/kg/min，灌流液温度 20-28°C；根据停循环时间将核心温度冷却至 18-30°C；采用 alpha-stat pH 值管理；红细胞压积 25-30%；近红外光谱监测脑灌注；当预计 SACP 持续时间较长时采用双侧灌注。
