Elbaser Ibrahim Ibrahim Abd, El Derie Ahmad Abd El Aleem
Department of Anaesthesia and Surgical Intensive Care, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Turk J Anaesthesiol Reanim. 2020 Feb;48(1):44-49. doi: 10.5152/TJAR.2019.32956. Epub 2019 Oct 4.
The aim of the present study was to evaluate the efficacy of extrathoracic jugulo-femoral venous shunt (JFVS) in avoiding the need for cardiopulmonary bypass (CPB) during the bi-directional Glenn shunt (BDGS) procedure.
A total of 40 patients aged between 9 and 36 months were enrolled in the present study. The patients were classified into two groups, group A (n=20) in which the patients had no veno-venous shunt and group B (n=20) in which the patients had extrathoracic JFVS. Patients requiring CPB, arterial oxygen saturation (SaO), heart rate, mean arterial pressure (MAP) and central venous pressure (CVP) were recorded during surgery. Postoperative time of intubation, intensive care unit (ICU) and hospital length of stays and neurological complications were also recorded.
The number of patients who needed urgent CPB was greater in group A than in group B. Intraoperative MAP was significantly lower in group A than in group B 10 min after clamping of the superior vena cava (SVC) and 30 min after declamping of the SVC. The CVP was significantly lower, and arterial SaO was significantly higher in group B than in group A 10 min after clamping of the SVC. The duration of postoperative intubation was significantly shorter in group B than in group A, and the ICU length of stay was shorter in group B than in group A. The hospital length of stay was similar in both groups. Postoperative neurological deficits were comparable in both groups.
The use of extrathoracic JFVS during the BDGS procedure avoided the use of CPB, maintained MAP and prevented any significant increase in SVC pressure.
本研究旨在评估胸外颈股静脉分流术（JFVS）在双向格林分流术（BDGS）过程中避免使用体外循环（CPB）的疗效。
本研究共纳入40例年龄在9至36个月之间的患者。患者被分为两组，A组（n = 20）患者未进行静脉 - 静脉分流，B组（n = 20）患者进行胸外JFVS。记录手术期间需要CPB的患者、动脉血氧饱和度（SaO）、心率、平均动脉压（MAP）和中心静脉压（CVP）。还记录术后插管时间、重症监护病房（ICU）和住院时间以及神经并发症。
A组需要紧急CPB的患者数量多于B组。在夹闭上腔静脉（SVC）后10分钟和松开SVC后30分钟，A组术中MAP显著低于B组。在夹闭SVC后10分钟，B组CVP显著低于A组，动脉SaO显著高于A组。B组术后插管持续时间显著短于A组，ICU住院时间短于A组。两组住院时间相似。两组术后神经功能缺损情况相当。
在BDGS手术中使用胸外JFVS避免了CPB的使用，维持了MAP并防止SVC压力显著升高。
