Bonatti J, Watzka S, Antretter H, Germann R, Flora G, Dapunt O E
University Clinic of Surgery I, Innsbruck/Austria.
Thorac Cardiovasc Surg. 1996 Jun;44(3):136-9. doi: 10.1055/s-2007-1012002.
The use of distal perfusion in descending thoracic and thoracoabdominal aortic surgery remains a controversial issue. Few mainly retrospective studies which directly compare simple clamping with distal perfusion are available. The aim of the present study was such a comparison in an own series of descending and thoracoabdominal aortic replacement. The records of 29 patients who underwent descending or thoracoabdominal aortic replacement between 1988 and 1994 were retrospectively reviewed. Patients were divided into two groups. Group I consisted of 14 patients who received aortic replacement using simple clamping, group II was represented by 15 patients who were operated with distal perfusion techniques. In group II left heart bypass with a centrifugal pump was used in 3 patients, and partial cardiopulmonary bypass with a roller pump in 12 patients. The paraplegia/paraparesis rate was 28.6% in group I and 0.0% in group II (p = 0.0258). There were no statistically significant differences regarding surgical revision for bleeding (14.3% in group I, 14.0% in group II), postoperative renal failure (14.3% in group I 13.3% in group II), postoperative ventilator dependence (9.0 days in group I, 11.2 days in group II), rate of postoperative multisystem organ failure (26.7% in group I, 33.3% in group II), length of stay in the ICU (13.6 days in group I and 13.9 days in group II), and 30-day mortality (21.4% in group I and 33.3% in group II). Methods of distal perfusion in comparison to simple clamping can lead to a lower paraplegia/paraparesis rate in descending and thoracoabdominal aortic surgery.
在降胸段和胸腹主动脉手术中使用远端灌注仍然是一个有争议的问题。很少有直接比较单纯阻断与远端灌注的主要回顾性研究。本研究的目的是在我们自己的一系列降胸段和胸腹主动脉置换病例中进行这样的比较。回顾性分析了1988年至1994年间接受降胸段或胸腹主动脉置换的29例患者的记录。患者分为两组。第一组由14例接受单纯阻断主动脉置换的患者组成，第二组由15例采用远端灌注技术进行手术的患者组成。第二组中，3例患者使用离心泵进行左心转流，12例患者使用滚压泵进行部分体外循环。第一组截瘫/轻瘫发生率为28.6%，第二组为0.0%（p = 0.0258）。在出血的手术修正（第一组14.3%，第二组14.0%）、术后肾衰竭（第一组14.3%，第二组13.3%）、术后呼吸机依赖（第一组9.0天，第二组11.2天）、术后多系统器官衰竭发生率（第一组26.7%，第二组33.3%）、重症监护病房住院时间（第一组13.6天，第二组13.9天）和30天死亡率（第一组21.4%，第二组33.3%）方面，两组之间无统计学显著差异。与单纯阻断相比，远端灌注方法可降低降胸段和胸腹主动脉手术中的截瘫/轻瘫发生率。
