Akimoto T, Hashimoto A, Aomi S, Hirayama T, Kitamura M, Koyanagi T, Imamaki M, Yamaki F, Tagusari O, Koyanagi H
Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
Nihon Kyobu Geka Gakkai Zasshi. 1993 Aug;41(8):1323-9.
Several methods have been used for an adjunct to perform operation of aortic arch aneurysms. However, their results were often not so reasonable. Recently retrograde cerebral perfusion was reported as a new adjunctive method. In our institute, for the past 6 and a half years from May 1985 to April 1992, 50 patients underwent reconstruction of the transverse aortic arch by using two methods of artificial cerebral perfusion. One method is continuous antegrade cerebral perfusion (ACP, for 32 patients), and the other is continuous retrograde cerebral perfusion (RCP, for 18 patients), each technique was combined with deep hypothermia (18-20 degrees C) and low flow perfusion (10-30 ml/kg/min) to lower half body performed from femoral artery. In our RCP circuit, an additional pump was used for cerebral perfusion to superior vena cava, but the circuit was much simpler than the circuit in ACP. We compared the two methods (ACP versus RCP) as regards to the following items and the results were showed in parentheses; hospital death (8/32, 25%: 2/18, 11%), respiratory complication (8.27, 30%: 3/18, 17%), neurological complication (7/29, 24%: 1/18, 5.5%), duration of extracorporeal circulation (306.8 +/- 74.5 min: 260.4 +/- 60.0 min), periods of pre-ECC in the operation (160.3 +/- 69.2 min: 117.7 +/- 35.3 min), duration of cerebral perfusion (113.6 +/- 45.4 min: 74.1 30.5 min) and amount of bleeding (3424 +/- 2881 ml: 1802 +/- 1291 ml). RCP has superior advantages in all of those in comparison with ACP. These results suggest that RCP is a useful adjunctive method for reconstruction of aortic arch with a low operative risk.
已经有几种方法被用作辅助手段来进行主动脉弓动脉瘤手术。然而，它们的效果往往不尽如人意。最近，逆行脑灌注被报道为一种新的辅助方法。在我们研究所，从1985年5月到1992年4月的过去6年半时间里，50例患者采用两种人工脑灌注方法进行了主动脉弓横部重建。一种方法是持续顺行脑灌注（ACP，32例患者），另一种是持续逆行脑灌注（RCP，18例患者），每种技术都与深低温（18 - 20摄氏度）和低流量灌注（10 - 30毫升/千克/分钟）相结合，从股动脉对下半身进行灌注。在我们的RCP回路中，额外使用一个泵向上腔静脉进行脑灌注，但该回路比ACP回路简单得多。我们就以下项目对两种方法（ACP与RCP）进行了比较，结果如下（括号内所示）；医院死亡率（8/32，25%：2/18，11%）、呼吸并发症（8/27，30%：3/18，17%）、神经并发症（7/29，24%：1/18，5.5%）、体外循环时间（306.8±74.5分钟：260.4±60.0分钟）、手术中体外循环前时间（160.3±69.2分钟：117.7±35.3分钟）、脑灌注时间（113.6±45.4分钟：74.1±30.5分钟）和出血量（3424±2881毫升：1802±1291毫升）。与ACP相比，RCP在所有这些方面都具有优势。这些结果表明，RCP是一种用于主动脉弓重建且手术风险较低的有用辅助方法。
