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|本期目录/Table of Contents|

 胸部降主动脉瘤体外循环方法探讨()

《中国胸心血管外科临床杂志》[ISSN:1007-4848/CN:51-1492/R]

期数:
2010年第17卷第3期
页码:
211-214
栏目:
临床研究论著
出版日期:
2010-06-25

文章信息/Info

Title:
 Evaluation of Cardiopulmonary Bypass Technique in Treating Descending Aortic Aneurysms
文章编号:
10074848（2010）03021104
作者:
 王军 徐志云 邹良建 等
第二军医大学长海医院 胸心外科,上海 200433
Author(s):
 WANG Jun;  XU Zhi-yun;  ZOU Liang-jian; et al . 
 Department of Cardiothoracic Surgery, Changhai Hospital, the Second Military Medical University, Shanghai 200433, P. R. China;
关键词:
 ; 降主动脉瘤;  体外循环;  深低温停循环;  逆行灌注中图分类号：
Keywords:
 ; Descending aortic aneurysm;  Cardiopulmonary bypass;  Deep hypothermic circulatory arrest;  Retrograde perfusion 
分类号:
R654.1
DOI:
-
文献标识码:
A
摘要:
 目的 探讨胸部降主动脉瘤手术中采用不同体外循环方法的临床效果及对大脑的保护作用。 方法 分析2001年1月至2008年12月我院术前经磁共振成像（MRI）确诊为胸部降主动脉瘤65例患者的临床资料，男56例，女9例；年龄15～71岁，平均年龄48.1岁；病程6 d～4个月（19.0±6.5 d）。术前临床诊断为DeBakeyⅢ型夹层41例，马凡综合征手术后并存或并发Ⅲ型夹层9例，假性动脉瘤7例，真性动脉瘤8例。施行人工血管补片修补降主动脉破口2例，动脉瘤切除人工血管置换术63例，其中降主动脉置换术＋肋间动脉移植术18例。 结果 65例患者采用的体外循环方法包括左心转流13例，全心转流12例，深低温停循环（DHCA）全身逆行灌注（TBRP）30例，改良上下半身分离体外循环10例。体外循环时间51～212 min，DHCA时间18～75 min，逆行灌注时间18～73 min，上半身停循环时间21～31 min，下半身停循环时间39～67 min。所有患者无1例手术死亡；未发生大脑并发症，无1例瘫痪并发症发生。术后早期死亡2例，均死于无尿性肾功能衰竭。 结论 根据胸部降主动脉瘤发生的解剖部位和范围选择不同的体外循环方法，能够取得良好的效果；选择的标准是要有利于手术操作，器官保护效果确实，操作方法简单。
Abstract:
 Objective To investigate the clinical effects and the brain protection effect of different cardiopulmonary bypass in treating descending aortic aneurysms. Methods From January 2001 to December 2008, 65 patients were diagnosed to have descending aortic aneurysm with magnetic resonance imaging (MRI) in our hospital. Among them, there were 56 males and 9 females whose age was between 15 and 71 years old with an average of 48.1 years. The disease process ranged from 6 days to 4 months (19.0±6.5 d ). Preoperative diagnosis showed that there were 41 cases of DeBakey type Ⅲinterlayer, 9 cases of Marfan syndrome with postoperative complications of type Ⅲ interlayer, 7 cases of pseudoaneurysm and 8 cases of true aneurysm. We adopted artificial blood vessel repair patch to repair the damaged point of the descending aorta in 2 cases, performed vascular aneurysm resection and artificial vessel replacement on 63 patients, and carried out descending aorta replacement and intercostal artery grafting in 18 cases. Results Among the 65 cases of cardiopulmonary bypass patients, there were 13 cases of left heart bypass, 12 cases of heart bypass, 30 cases of deep hypothermic circulatory arrest (DHCA) with total body retrograde perfusion (TBRP) and 10 cases of modified separate perfusion of upper and low body. Cardiopulmonary bypass time, DHCA time, retrograde perfusion time, upper body circulatory arrest time and low body circulatory arrest time were respectively 51-212 min, 18-75min, 18-73 min, 21-31 min, and 39-67 min. No death occurred during the operation, and there were no brain complications or complications of paralysis among all the patients. Two patients died after operation because of renal failure. Conclusion Good results can be achieved by selecting different method of cardiopulmonary bypass based on the anatomical location and range of the thoracic descending aortic aneurysms. The selection criteria should be favorable to the surgical operation and organ protection.

参考文献/References

备注/Memo

备注/Memo:
更新日期/Last Update: 2010-07-06