主动脉弓部手术脑保护效果临床分析.doc

主动脉弓部手术脑保护效果临床分析 目录 TOC \o 1-9 \h \z \u 目录 1 正文 1 文1：主动脉弓部手术脑保护效果临床分析 1 1 资料与方法 2 2 结 果 5 3 讨 论 6 文2：不同脑灌注方法在主动脉弓部手术中的应用 8 1 DHCA 9 2 RCP 10 3 SCP 11 4 手术效果与经验和病例组成有关 13 参考文摘引言： 16 原创性声明（模板） 17 文章致谢（模板） 18 正文 主动脉弓部手术脑保护效果临床分析 文1：主动脉弓部手术脑保护效果临床分析 Abstract: OBJECTIVE To summarize the clinical experiences of brain protection for aortic arch operatio surgery. METHODS From Jan 2000 to june 2007, 118 patients with aortic arch operation were performed under deep hypothermic circulatory arrest (DHCA) for extracorporeal circulation（ECC）with methods of brain protection by retrograde cerebral perfusion (RCP) and antegrade selective cerebral perfusion (SCP). Surgical procedures included ascending aortic and hemiarch grafting in 76 cases. Ascending and total arch grafting in 42 cases. RESULTS In accordance with difference operation, 57 cases used SVC-RCP perfusion, 11 cases used SIVC-RCP perfusion, 9 cases used total body retrograde perfusion (TbrP) and 45 cases used SCP perfusion. The ECC time, DHCA time, RCP time and SCP time of all patients were 81-284 min, 9-120 min, 9-110 min and 31-62 min respectively. After operation, 9 cases had temporary mental anomaly, 9 cases had renal iufficience, 15 cases had respiratory iufficiency, 9 cases had multiple organ failure and 7cases died (operative mortality was %).CONCLUSION DHCA＋RCP and DHCA＋SCP are both effective methods for aortic arch surgery while the latter is more suitable for complicated aortic arch surgery. Key words： Aortic arch；Deep hypothermic circulatory arrest；Selective cerebral perfusion；brain protection 主动脉弓部手术复杂，脑部并发症多，手术风险高，近10年主动脉弓部手术死亡率虽有明显降低，但仍显著高于升主动脉瘤手术，尤其是急性A型主动脉夹层施行主动脉弓部手术的死亡率接近20％ ［1］。术中如何采用大脑保护措施是手术成功 的关键之一，我2000年1月至2007年6月间共行主动脉弓部动脉瘤手术118例，取得了比较满意的大脑保护效果。 1 资料与方法 临床资料 2000年1月至2007年6月间共行主动脉弓部动脉瘤手术118例，男性93例，女性25例，年龄16～82（±）岁,体重～（±）kg,身高153～189（±）cm,病程6天～4个月（±天）。病种及术前合并症见表1和表2。所有病例均经心脏超声和胸部CT检查明确诊断，其中61例行MRI血管重建明确诊断和病变性质及范围。左室射血分数（EF）29％～80％，EF≤40％的有9例，左室收缩末期直径≥55 mm者14