颞浅动脉压指导主动脉弓手术患者深低温停循环期间选择性脑灌注的效果

Efficacy of superficial temporal artery pressure-guided selective cerebral perfusion during deep hy- pothermic circulatory arrest in patients undergoing aortic arch surgery

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摘要目的评价颞浅动脉压指导主动脉弓手术患者深低温停循环（DHCA）期间选择性脑灌注（SCP）的效果。方法行主动脉弓部手术患者96例，性别不限，年龄35～64岁，BMI19～23kg／m^2，ASA分级Ⅲ或Ⅳ级，采用随机数字表法分为2组（n=48）：颞浅动脉压组（A组）和临床经验组（B组）。A组气管插管术后行颞浅动脉穿刺置管术，监测动脉压。DHCA期间，A组调整SCP灌注流量，维持颞浅动脉压目标值30～40mmHg；B组于DHCA期间根据临床经验，设定SCP灌注量5～10ml·kg·min^-1记录SCP灌注量、苏醒时间、气管拔管时间、ICU停留时间。评价术后住院期间神经功能，记录永久性神经功能障碍和短暂性神经功能障碍的发生情况和院内死亡情况。结果与B组比较，A组SCP灌注流量降低，苏醒时间、气管拔管时间和ICU停留时间缩短，永久性和短暂性神经功能障碍发生率（分别为2％和4％）降低（P〈0．05），院内死亡率比较差异无统计学意义（P〉0．05）。结论维持颞浅动脉压30～40mmHg是指导主动脉弓手术患者DHCA期间SCP的可靠方法。 Objective To evaluate the efficacy of superficial temporal artery （STA） pressureguided selective cerebral perfusion （SCP） during deep hypothermic circulatory arrest （DHCA） in patients undergoing aortic arch surgery. Methods Ninety-six patients of both sexes, aged 35-64 yr, with body mass index of 19-23 kg/m^2 , of American Society of Anesthesiologists physical status m or rV, undergoing aortic arch surgery, were divided into STA pressure group （group A ） and clinical experience group （group B） using a random number table, with 48 patients in each group. In group A, STA catheterization was performed after tracheal intubation, and arterial pressure was monitored. SCP flow was adjusted to main tain the target value of STA pressure between 30 and 40 mmHg during DHCA in group A. SCP flow rate was set at 5-10 ml·kg·min^-1 according to clinical experience in group B. The volume of fluid perfused during SCP, emergence time, extubation time and duration of intensive care unit stay were recorded. Neurological function was evaluated during length of hospitalization after surgery, and the development of permanent and transient neurological dysfunction and mortality in hospital were recorded. Results Cornpared with group B, the volume of fluid perfused during SCP was significantly decreased, the emergence time, extuhation time and duration of intensive care unit stay were shortened, the incidence of permanent and transient neurological dysfunction （2% and 4%, respectively） was decreased （P 〈 0.05） , and no significant change was found in the mortality rate in hospital in group A （P〉0.05）. Conclusion Maintaining STA pressure at 30-40 mmHg is a reliable method for guiding SCP during DHCA in patients undergo- ing aortic arch surgery.