Ⅰ型夹层在深低温停循环中高氧脑保护.doc

Ⅰ型夹层在深低温停循环中高氧脑保护 　　【摘要】 目的 探讨DeBakeyⅠ型主动脉夹层患者在深低温停循环选择性脑灌注期间的高氧脑保护情况。方法 53例DeBakeyⅠ型主动脉夹层患者， 在深低温的情况下， 经头臂干选择性脑灌， 维持动脉氧分压在较高水平， 完成支架象鼻及弓部置换后， 恢复下半身循环， 缓慢复温， 鼻咽温37℃， 肛温36℃时， 各项指标正常后， 停机。观察效果。结果 患者体外循环时间为（197.8±33.9）min， 心肌阻断时间为（105.8±22.3）min， 深低温停循环选择性脑灌时间为（36.1±9.0）min， 死亡2例， 短暂性神经功能障碍6例， 左下肢瘫痪1例， 其余均痊愈出院。结论 DeBakeyⅠ型主动脉夹层患者在深低温停循环选择性脑灌期间， 维持动脉氧分压在较高水平， 能提供较满意的脑保护效果， 有利于脑保护 【关键词】 DeBakeyⅠ型主动脉夹层； 深低温停循环；选择性脑灌注；高氧分压；脑保护 DOI：10.14163/j.cnki.11-5547/r.2016.33.072 Hyperoxia cerebral protection by type Ⅰ interlayer in deep hypothermic circulatory arrest MENG Fan-wei， LIN Hong-qi. Department of Anesthesiology， Henan Province Peoples Hospital， Xinxiang 453000， China 【Abstract】 Objective To investigate hyperoxia cerebral protection by type Ⅰ aortic interlayer in selective cerebral perfusion period of deep hypothermic circulatory arrest. Methods A total of 53 patients with DeBakey type Ⅰ aortic interlayer received deep hypothermic selective cerebral perfusion through truncus brachiocephalicus， with high level of arterial partial pressure of oxygen. Lower body circulation recovered after trunk and arch replacement. Temperature recovered to 37℃ as nasopharyngeal temperature and 36℃ as anal temperature. Halt was made after recovered indexes to observe effect. Results The patients had extracorporeal circulation time as （197.8±33.9） min， myocardial block time as （105.8±22.3） min， and elective cerebral perfusion period of deep hypothermic circulatory arrest as （36.1±9.0） min. There were 2 death cases， 6 cases with transient dysneuria and 1 case with left lower limb paralysis， and the other patients were cured and discharged. Conclusion High level of arterial partial pressure of oxygen during selective cerebral perfusion period of deep hypothermic circulatory arrest in patients with DeBakey type Ⅰ aortic interlayer provides satisfactory cerebral protection effect， and this method is beneficial for cerebral protection. 【Key words】 DeBakey type Ⅰ aortic interlayer； Dee