单纯无名动脉灌注的主动脉弓置换术21例

摘要

目的 探讨主动脉弓置换术中使用单纯无名动脉灌注进行脑保护的安全性和有效性.方法 2004年1月至2007年7月,2l例主动脉弓置换者使用单纯无名动脉灌注技术进行脑保护,男19例,女2例;年龄29-72岁,平均(46.5±11.4)岁.A型(Stanford分型)主动脉夹层19例,其中7例合并主动脉瓣关闭不全;升主动脉及主动脉弓真性动脉瘤伴降主动脉受累2例.所有病例均在深低温、使用单纯无名动脉选择性脑灌注下进行升主动脉、主动脉弓置换+降主动脉覆膜支架置入术.同时行Benlall手术6例,David手术1例.结果 升主动脉阻断(109.6.4-29.6)min;体外循环(186.7±56.2)min;最低鼻咽温(19.O±3.3)℃;选择性脑灌注时间(38.3.4-11.5)Ⅲ.m,流量每分钟(6.8±2.6)ml,l‘g.术后无中枢神经系统并发症.呼吸机辅助(38.6±29.O)h.1例因低心排输出量综合征于术后第5 d死亡.术后随访2-45个月,平均(24.0±12.5)个月,无死亡及心脑血管意外发生.结论 深低温、单纯无名动脉选择性脑灌注下行主动脉弓置换是安全、有效的.%Objective To study the safety and effectiveness of pure innominste artery perfusion technique in total arch replace-ment. Methods From January 2004 to July 2007,21patients received total arch replacement by using pure innominate artery perfu-sion techmique.Nineteen were male and 2female.The average age was (46.5±11.4) years (29-72 years).Nineteen patients were type A dissection and 2 patients with aneurysm involving ascending sorta and sortic arch.Among them,7 patients had moderate to se-ver aortic regurgitation.Innominate artery was not involved in all patients.All patients received ascending sorta and arch replacement under hypothermia circulation arrest(HCA) with selective ante-grade cerebral perfusion through innominate arter(SACP).Stent ele-phant trunk technique was used in all patients.Six patients combined with Bentall's operation and David operation was concomitanted in one patient.Results There was no central nervous system complication postoperatively.Respiratory assist duration was(38.64±29.0)hours.One patient died of beart failure on the 5th postoperative day.All survival patients were follwed(24.0±12.5) months (2-45 months).There was no death or severe complication during follow up.Conclusion Pure innominate artery perfusion tech-mique is ssfe and effective in total arch replacement.