Lin P J, Chang C H, Tan P P, Wang C C, Chang J P, Liu D W, Chu J J, Tsai K T, Kao C L, Hsieh M J
Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan, Republic of China.
J Thorac Cardiovasc Surg. 1994 Nov;108(5):969-74.
Hypothermic circulatory arrest is commonly used to facilitate repair of complex congenital heart defects and aortic lesions and for complex neurosurgical procedures. However, extended periods of circulatory arrest may impair cerebral metabolism and cause ischemic injury. Retrograde cerebral perfusion has been applied recently in aortic surgery to protect the brain. From January 1991 to December 1993, 29 patients underwent emergency operations to repair acute type A aortic dissection with the aid of hypothermic circulatory arrest. Six patients received hypothermic circulatory arrest without retrograde cerebral perfusion with a rectal temperature of 16.4 degrees +/- 0.9 degrees C (mean +/- standard error of the mean, group 1). Retrograde cerebral perfusion during hypothermic circulatory arrest was performed in 15 patients with a rectal temperature of 15.9 degrees +/- 0.5 degrees C (group 2) and in eight patients with a rectal temperature of 21.7 degrees +/- 0.8 degrees C (group 3). The hypothermic circulatory arrest times were 25 +/- 4, 42 +/- 4, and 63 +/- 6 minutes, respectively (p < 0.05). The cardiopulmonary bypass times were 173 +/- 5, 184 +/- 7, and 143 +/- 6 minutes, respectively (p < 0.05). All patients survived the operation and regained consciousness with no neurologic defects. Follow-up (mean 23.2, 14.5, and 5.1 months, respectively) was complete in all patients except one. This patient, from group 2, was killed in a road traffic accident 12 months after the operation. Our experience suggests that retrograde cerebral perfusion can effectively protect the brain from ischemic injury and extend the safe period of hypothermic circulatory arrest. With the aid of retrograde cerebral perfusion, prolonged circulatory arrest can probably be performed safely with moderate hypothermia.
低温循环停止常用于促进复杂先天性心脏缺陷和主动脉病变的修复以及复杂神经外科手术。然而，长时间的循环停止可能会损害脑代谢并导致缺血性损伤。近来，逆行脑灌注已应用于主动脉手术以保护大脑。1991年1月至1993年12月，29例患者在低温循环停止辅助下接受急诊手术修复急性A型主动脉夹层。6例患者在直肠温度为16.4℃±0.9℃（均值±均值标准误差，第1组）时接受了无逆行脑灌注的低温循环停止。15例直肠温度为15.9℃±0.5℃的患者（第2组）和8例直肠温度为21.7℃±0.8℃的患者（第3组）在低温循环停止期间进行了逆行脑灌注。低温循环停止时间分别为25±4、42±4和63±6分钟（p<0.05）。体外循环时间分别为173±5、184±7和143±6分钟（p<0.05）。所有患者均手术存活且恢复意识，无神经功能缺陷。除1例患者外，所有患者均完成随访（分别平均为23.2、14.5和5.1个月）。该患者来自第2组，术后12个月死于交通事故。我们的经验表明，逆行脑灌注可有效保护大脑免受缺血性损伤，并延长低温循环停止的安全期。借助逆行脑灌注，可能在中度低温下安全地进行长时间循环停止。
