2024 年第 12 期 第 0 卷

主动脉弓部手术不同脑灌注方法对神经系统并发症的影响

Effects of different cerebral perfusion methods on neurological complications in aortic arch surgery

作者：王金宏1杨峰1王晓朦2黑飞龙1

英文作者：Wang Jinhong1 Yang Feng1 Wang Xiaomeng2 Hei Feilong1

单位：1首都医科大学附属北京安贞医院体外循环及机械循环辅助科，北京100029；2首都医科大学附属北京安贞医院心脏外科危重症中心，北京100029

英文单位：1Department of Extracorporeal Circulation and Mechanical Circulation Assistance Beijing Anzhen Hospital Capital Medical University Beijing 100029 China; 2Center for Cardiac Surgery Intensive Care Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：主动脉弓部手术；脑保护；神经系统并发症

英文关键词：Aorticarchsurgery;Cerebralperfusion;Neurologicalcomplications

• 摘要：

• 目的 评价主动脉弓部手术体外循环期间不同脑灌注方法对神经系统并发症的影响。方法 回顾性分析2019年7月至2022年5月在首都医科大学附属北京安贞医院行主动脉弓部手术的241例患者的临床资料，根据不同的脑灌注方法分为双侧脑灌注组和单侧脑灌注组。比较2组患者手术情况、术后30 d住院死亡率和神经系统并发症发生率。结果 本研究共入选浅低温停循环联合双侧顺行脑灌注患者119例（双侧脑灌注组），中低温停循环联合单侧顺行脑灌注患者122例（单侧脑灌注组）。单侧脑灌注组患者的体外循环时间长于双侧脑灌注组［187（155,207）min比176（143,198）min］，脑灌注流量、术中最低温度、围手术期血浆使用量均低于双侧脑灌注组［6（5，7）ml/（kg·min）比8（7，10）ml/（kg·min）、25（24，25）℃比28（27，30）℃、0（0，400）ml比0（0，400）ml］(均P＜0.05)。2组患者术后30 d住院死亡率比较差异无统计学意义（P=0.168）。2组患者永久性神经系统并发症和暂时性神经系统并发症发生率比较差异均无统计学意义（P=0.951、0.843）。结论 主动脉弓部手术时，单侧脑灌注和双侧脑灌注对神经系统并发症的发生率无影响，但是双侧脑灌注患者可以耐受更高的温度并且减少体外循环时间。

• Objective To evaluate the effects of different cerebral perfusion methods on neurological complications during cardiopulmonary bypass in aortic arch surgery. Methods The clinical data of 241 patients who underwent aortic arch surgery in Beijing Anzhen Hospital, Capital Medical University from July 2019 to May 2022 were retrospectively analyzed. According to different cerebral perfusion methods, they were divided into bilateral cerebral perfusion group and unilateral cerebral perfusion group. The operation conditions, 30-day in-hospital mortality and incidence of neurological complications were compared between the two groups. Results A total of 119 patients with mild hypothermic circulatory arrest combined with bilateral antegrade cerebral perfusion (bilateral cerebral perfusion group) and 122 patients with moderate hypothermic circulatory arrest combined with unilateral antegrade cerebral perfusion (unilateral cerebral perfusion group) were enrolled in this study.The duration of cardiopulmonary bypass was longer in the unilateral cerebral perfusion group than that in the bilateral cerebral perfusion group ［187(155,207)min vs 176(143,198)min］, and cerebral perfusion flow, minimum intraoperative temperature, and perioperative plasma consumption were lower in the bilateral cerebral perfusion group ［6(5，7)ml/(kg·min) vs 8(7，10)ml/(kg·min), 25(24，25)℃ vs 28(27，30)℃, 0(0，400)ml vs 0(0，400)ml］(all P＜0.05). There was no significant difference in 30-day in-hospital mortality between the two groups(P=0.168). There was no significant difference in the incidence of permanent neurological complications and temporary neurological complications between the two groups（P=0.951, 0.843）. Conclusion In aortic arch surgery, unilateral cerebral perfusion and bilateral cerebral perfusion have no effect on the incidence of neurological complications, but bilateral cerebral perfusion can tolerate higher temperature and reduce cardiopulmonary bypass time.