深低温停循环与选择性顺行性脑灌注在小儿主动脉弓手术中的应用效果比较

Comparasion between deep hypothermic circulatory arrest and selective antegrade cerebral perfusion during pediatric aortic arch surgery

摘要:

目的：比较深低温停循环（deep hypothermic circulatory arrest，DHCA）与选择性顺行性脑灌注（selective antegrade cere－bral perfusion，SACP）在小儿主动脉弓手术中的应用效果。方法：回顾性分析我院2008年1月至2012年3月60例在体外循环下行主动脉缩窄或主动脉弓中断合并心内畸形矫治术患儿的临床资料，根据脑保护方法分为DHCA组（n=23）和SACP组（n=37），对其术中体外循环转流情况和术后恢复情况进行比较。结果：与DHCA组比较，SACP组转流中最低鼻咽温和最低直肠温显著升高（P<0.05）；术后24 h胸腔引流量、术后机械通气时间比较，显著降低（P<0.05）。2组死亡率、神经系统并发症、急性肾功能衰竭和低心排出量综合征发生率差异无统计学意义（P >0.05）。结论：小儿主动脉弓手术中DHCA与SACP的脑保护效果相似。SACP有利于术后呼吸功能的恢复，减少术后出血。

Abstract:

Objective：To evaluate the efficacy between deep hypothermic circulatory arrest（DHCA） and selective antegrade cerebral perfusion（SACP） used in pediatric aortic arch surgery. Methods：Sixty cases undergoing repair of coarctation of aorta or interrupted aortic arch complicated with cardiac monstrosity from January 2008 to March 2012 in our hospital were retrospectively reviewed. They were divided into two groups according to the method of cerebral protection：DHCA group（n=23） and SACP group（n=37）. Periopera－tive variables between the two groups were compared. Results：The lowest nasopharyngeal and rectal temperatures were significantly higher，postoperative intubation time was longer and thorax output during postoperative 24 h was larger in SACP group than in DHCA group（P<0.05）. There was no significant difference between two groups in terms of hospital mortality，occurrence of postoperative neurological complication，acute renal failure and low cardiac output syndrome（P >0.05）. Conclusions：Cerebral protective effect of DHCA and SACP in pediatric aortic arch surgery is comparable. SACP has the advantages of better recovery of respiratory function and less postoperative blooding.