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本文引用的文献

1
Out-of-Hospital 30-day Deaths After Cardiac Surgery Are Often Underreported.心脏手术后院外 30 天死亡率常被低估。
Ann Thorac Surg. 2020 Jul;110(1):183-188. doi: 10.1016/j.athoracsur.2019.09.061. Epub 2019 Nov 9.
2
Deep Hypothermia With Retrograde Cerebral Perfusion Versus Moderate Hypothermia With Antegrade Cerebral Perfusion for Arch Surgery.深低温逆行性脑灌注与中低温顺行性脑灌注在主动脉手术中的应用比较。
Ann Thorac Surg. 2019 Apr;107(4):1104-1110. doi: 10.1016/j.athoracsur.2018.10.008. Epub 2018 Nov 15.
3
Too Cold to Clot? Does Intraoperative Hypothermia Contribute to Bleeding After Aortic Surgery?太冷而无法凝血？术中低温会导致主动脉手术后出血吗？
Aorta (Stamford). 2017 Aug 1;5(4):106-116. doi: 10.12945/j.aorta.2017.16.049. eCollection 2017 Aug.
4
Does moderate hypothermia really carry less bleeding risk than deep hypothermia for circulatory arrest? A propensity-matched comparison in hemiarch replacement.中低温相较于深低温在停循环中真的具有更低的出血风险吗？在半弓置换术中的倾向评分匹配比较。
J Thorac Cardiovasc Surg. 2016 Dec;152(6):1559-1569.e2. doi: 10.1016/j.jtcvs.2016.08.014. Epub 2016 Aug 28.
5
Which Method of Cerebral Protection Do You Prefer to Use for Aortic Arch Surgery?在主动脉弓手术中，你更倾向于使用哪种脑保护方法？
Aorta (Stamford). 2013 Jun 1;1(1):69-70. doi: 10.12945/j.aorta.2013.13.018. eCollection 2013 Jun.
6
Moderate versus deep hypothermic circulatory arrest for elective aortic transverse hemiarch reconstruction.中度低温与深度低温循环停止用于择期主动脉横断半弓重建术
Ann Thorac Surg. 2015 May;99(5):1511-7. doi: 10.1016/j.athoracsur.2014.12.067. Epub 2015 Mar 29.
7
Belt and suspenders: can we keep them in the drawer?双保险：我们能把它们束之高阁吗？
J Thorac Cardiovasc Surg. 2014 Dec;148(6):2917-9. doi: 10.1016/j.jtcvs.2014.09.101.
8
Brain protection in aortic arch surgery: antegrade cerebral perfusion and retrograde cerebral perfusion need a tougher row to hoe.主动脉弓手术中的脑保护：顺行性脑灌注和逆行性脑灌注面临更艰巨的任务。
J Thorac Cardiovasc Surg. 2014 Dec;148(6):2902-4. doi: 10.1016/j.jtcvs.2014.09.041. Epub 2014 Sep 18.
9
Is there a need for adjunct cerebral protection in conjunction with deep hypothermic circulatory arrest during noncomplex hemiarch surgery?在非复杂性半弓手术中，在深度低温停循环的同时是否需要辅助脑保护？
J Thorac Cardiovasc Surg. 2014 Dec;148(6):2911-7. doi: 10.1016/j.jtcvs.2014.08.010. Epub 2014 Aug 13.
10
Safety and efficacy of retrograde cerebral perfusion as an adjunct for cerebral protection during surgery on the aortic arch.逆行脑灌注作为主动脉弓手术中脑保护辅助手段的安全性和有效性。
J Thorac Cardiovasc Surg. 2014 Dec;148(6):2927-33. doi: 10.1016/j.jtcvs.2014.07.024. Epub 2014 Jul 30.

半弓主动脉置换术中逆行脑灌注的改良技术

Modified Technique for Retrograde Cerebral Perfusion during Hemiarch Aortic Replacement.

作者信息

Kouchoukos Nicholas T, Haynes Marc, Hester Sarah, Castner Catherine F

机构信息

Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St. Louis, Missouri.

出版信息

Aorta (Stamford). 2021 Jun;9(3):100-105. doi: 10.1055/s-0041-1726279. Epub 2021 Oct 12.

DOI:10.1055/s-0041-1726279
PMID:34638147
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8598313/
Abstract

BACKGROUND

Uncertainty remains regarding the optimal method of brain protection for procedures that require repair or replacement of the aortic arch. We examined the early outcomes of a technique for brain protection in patients undergoing partial aortic arch (hemiarch) replacement that involves deep hypothermic circulatory arrest (DHCA) and retrograde cerebral perfusion (RCP) of cold blood from the superior vena cava toward the end of the arrest interval.

METHODS

During a recent 15-year interval, 520 patients underwent elective or urgent/emergent ascending aortic and hemiarch replacement as an isolated (47 patients) or combined (473 patients) procedure employing DHCA (mean nasopharyngeal temperature at circulatory arrest, 17.1°C and mean duration, 19.3 minutes) supplemented with RCP of cold blood from the superior vena cava toward the end of the arrest interval (mean, 6.7 minutes). The mean age of the patients was 59.5 years, and 65% were male.

RESULTS

The in-hospital and 30-day mortality rates were 1.2% (six patients). Seven patients (1.4%) sustained a stroke and 19 patients (3.7%) had transient neurologic dysfunction that completely resolved by the time of hospital discharge. Four patients (0.77%) developed postoperative renal failure requiring dialysis. Twenty-one patients (4%) required ventilator support for >48 hours and five patients (0.96%) required a tracheostomy. The median hospital length of stay was 6 days.

CONCLUSION

DHCA with a brief interval of RCP is a safe and effective technique for brain protection during hemiarch aortic replacement. RCP reduces the duration of brain ischemia and permits removal of particulate matter and air from the arterial circulation.

摘要

背景

对于需要修复或置换主动脉弓的手术，脑保护的最佳方法仍存在不确定性。我们研究了一种在接受部分主动脉弓（半弓）置换的患者中进行脑保护的技术的早期结果，该技术包括深度低温循环停搏（DHCA）以及在停搏期即将结束时从上腔静脉进行冷血逆行脑灌注（RCP）。

方法

在最近的15年期间，520例患者接受了择期或紧急/急诊升主动脉和半弓置换术，该手术为单独（47例患者）或联合（473例患者）手术，采用DHCA（循环停搏时平均鼻咽温度为17.1°C，平均持续时间为19.3分钟），并在停搏期即将结束时从上腔静脉补充冷血RCP（平均6.7分钟）。患者的平均年龄为59.5岁，65%为男性。

结果

住院和30天死亡率为1.2%（6例患者）。7例患者（1.4%）发生中风，19例患者（3.7%）出现短暂性神经功能障碍，出院时完全恢复。4例患者（0.77%）发生术后肾衰竭需要透析。21例患者（4%）需要呼吸机支持超过48小时，5例患者（0.96%）需要气管切开术。中位住院时间为6天。

结论

DHCA联合短暂的RCP是半弓主动脉置换术中脑保护的一种安全有效的技术。RCP可缩短脑缺血持续时间，并允许从动脉循环中清除颗粒物和空气。