Matsuda H, Nakano S, Shirakura R, Matsuwaka R, Ohkubo N, Ohtani M, Hirose H, Kawashima Y
First Department of Surgery, Osaka University Medical School, Japan.
Circulation. 1989 Sep;80(3 Pt 1):I243-8.
Deep-hypothermic cardiopulmonary bypass with selective cerebral perfusion (SCP) was used in 34 consecutive patients with aneurysms involving the aortic arch or the adjacent part of the aorta. The ages ranged from 25 to 79 years (mean, 56 years). Atherosclerotic aneurysms were present in 14 patients, dissecting aortic aneurysms in 16, and other lesion types in four. Replacement of the ascending aorta was performed in 10 patients, replacement of the ascending aorta and arch in 12, replacement of the distal arch in two, and other procedures in 10. Perfusion techniques consisted of femoral artery perfusion and SCP to the brachiocephalic trunk and the left common carotid artery. The blood temperature was maintained at 16 degrees-20 degrees C. SCP time ranged from 25 to 214 minutes (mean, 123 minutes). Operative death occurred in three (9%) patients. Neurological sequelae occurred in one patient (cerebral infarction), but significant respiratory and hemorrhagic problems were not encountered. For the SCP protocols, we advise that perfusion pressures at bilateral superficial temporal arteries be kept at approximately 50 mm Hg and that venous oxygen saturation of the superior vena caval line or internal jugular vein be kept at above 90%. With appropriate monitoring, this method can be performed in aortic arch or related surgeries with low morbidity results.
34例累及主动脉弓或主动脉相邻部位动脉瘤的患者连续采用了深低温体外循环加选择性脑灌注（SCP）。年龄范围为25至79岁（平均56岁）。14例患者存在动脉粥样硬化性动脉瘤，16例为主动脉夹层动脉瘤，4例为其他病变类型。10例行升主动脉置换，12例行升主动脉和主动脉弓置换，2例行主动脉弓远端置换，10例行其他手术。灌注技术包括股动脉灌注以及对头臂干和左颈总动脉进行SCP。血液温度维持在16℃至20℃。SCP时间为25至214分钟（平均123分钟）。3例（9%）患者发生手术死亡。1例患者出现神经后遗症（脑梗死），但未出现严重的呼吸和出血问题。对于SCP方案，我们建议双侧颞浅动脉的灌注压力保持在约50 mmHg，上腔静脉或颈内静脉的静脉血氧饱和度保持在90%以上。通过适当的监测，该方法可用于主动脉弓或相关手术，且发病率较低。
