目的 探讨全主动脉弓置换术中的体外循环及深低温停循环选择性脑灌注的管理.方法 DeBakeyⅠ主动脉瘤行主动脉弓全弓置换及主动脉远端支架植入术患者14例,均行右锁骨下动脉与右心房插管建立体外循环,在全身深低温停循环(DHCA)加顺行性选择性脑灌注(ASCP)下完成主动脉远端支架植入及弓部血管吻合后,开放升主动脉恢复全身体外循环灌注.结果 14例患者手术均顺利完成,术后未见明显神经并发症,全部痊愈出院.结论 选择性脑灌注能为全主动脉弓置换手术提供良好的保障.%Objective To summarize the management of cardiopulmonary bypass and antegrade selective cerebral perfusion ( ASCP) with deep hypothermic circulatory arrest ( DHCA) in surgery of DeBakey type Ⅰ aortic aneurysm in total aortic arch replacement. Methods Fourteen patients with DeBakey type Ⅰ aortic aneurysm underwent aortic arch replacement and distal aortic arch aneurysm stent grafting. Cannulation of right subclavian artery and right atrial were done to establish cardiopulmonary bypass. After distal aortic arch aneurysm stent grafting and arch anastomosis under DHCA and ASCP, then we opened ascending aorta and restarted systemic perfusion during cardiopulmonary bypass. Results All patients had no obvious neurological complications after surgery and discharged from hospital. Conclusion DHCA with ASCP is a safe and effective method for total aortic arch replacement.
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