Tanaka M, Takeuchi E, Watanabe T, Tamaki S, Tajima K, Maseki T, Abe T
Department of Thoracic Surgery, Nagoya University School of Medicine, Japan.
Nihon Geka Gakkai Zasshi. 1993 Mar;94(3):297-301.
Hypothermic circulatory arrest for aortic arch surgery can be tolerated for a limited period of time. To avoid this disadvantage, we used hypothermic cardiopulmonary bypass (CPB) with selective cerebral perfusion (SCP), in which the femoral artery, right axillary artery (RAA) and left common carotid artery (LCCA) were separately cannulated and perfused by individual pump heads. The pressures of bilateral superficial temporal arteries were monitored to maintain the cerebral perfusion pressure at 50 mmHg. The flow of RAA and LCCA was maintained at 5 ml/min/body weight kg, the pressure of each superficial temporal artery at 50 mmHg and the nasopharyngeal temperature at 20 degrees C. To perform the "open distal repair", the CPB was stopped while cerebral perfusion was maintained. Between 1986 and 1991, 20 patients were operated on with this method. Mean duration of SCP was 169 minutes (73 to 210), and mean duration of CPB was 290 minutes (136 to 472). There was no intraoperative death. Operative mortality rate within 30 days after surgery was 10% (2/20). Neurological sequelae occurred in one patient with emergency operation for acute aortic dissection, into LCC of whom we had trouble in inserting a cannula. It was considered that SCP could be performed for at least 2 hours with the results of good cerebral protection.
主动脉弓手术中的低温循环停搏在有限时间内是可以耐受的。为避免这一缺点，我们采用了选择性脑灌注（SCP）的低温体外循环（CPB），其中股动脉、右腋动脉（RAA）和左颈总动脉（LCCA）分别插管，并由单独的泵头进行灌注。监测双侧颞浅动脉的压力，以将脑灌注压维持在50 mmHg。RAA和LCCA的流量维持在5 ml/（min·kg体重），每条颞浅动脉的压力维持在50 mmHg，鼻咽温度维持在20℃。为进行“开放远端修复”，在维持脑灌注的同时停止CPB。1986年至1991年期间，有20例患者采用此方法进行手术。SCP的平均持续时间为169分钟（73至210分钟），CPB的平均持续时间为290分钟（136至472分钟）。术中无死亡病例。术后30天内的手术死亡率为10%（2/20）。1例因急性主动脉夹层急诊手术的患者出现神经后遗症，我们在该患者的LCC插管时遇到困难。认为SCP至少可以进行2小时，脑保护效果良好。
