Objective To explore the protection method of brain in whole bow replacement elephant trunk stents implantation in patients with Debakey type I aortic dissection merger internal carotid artery and basal arterial circulations narrow. Methods 46 cases of Debakey type I aortic dissection merger internal carotid artery and basal arterial circulations narrow were treated with whole bow replacement elephant trunk stents implacement. They were divided into A, Bl ,B2,C1 , C2 group according to the internal carotid artery and basal arterial circulations narrow degree, perfusion measure and method. Patients in group A and Bl received pure ultra-low temperature and axillary artery perfusion for 5 ~ 10 ml/( kg · min) ; simple ultra-low temperature and axillary artery perfusion for 10 ~ 15 ml/(kg · min)in group B2 and Cl, ultra-low temperature and axillary artery,left carotid artery perfusion measure for 10 ~ 15 ml/(kg · min)in group C2. Results Neurological complications were detected in 0 case in group A,3 cases in group Bl ,0 case in group B2,3 cases in group Cl ,0 case in group C2. The brain stem trigeminal evoked pote of patients in group B2 and C2 was lower than that in group Bl and Cl, all P<0. 05. Conclusion Increasing the perfusion measure and bilateral brain perfusion can protect brain function in whole bow replacement elephant trunk stents implantation in patients with Debakey type I aortic dissection merger internal carotid artery and basal arterial circulations narrow.%目的 探讨全弓置换象鼻支架置入术治疗Debakey Ⅰ型主动脉夹层/瘤合并颈内动脉及基底动脉环狭窄患者的脑保护方法.方法 46例Debakey Ⅰ型主动脉夹层/瘤合并颈内动脉及基底动脉环狭窄患者,均行全弓置换象鼻支架置人术治疗.根据颈内动脉和基底动脉环的狭窄程度、灌注量和方法将分为A、B1、B2、C1、C2组.A组(颈内动脉狭窄度＜50％)行单纯深低温停循环(DHCA)、右腋动脉选择性脑灌注,灌注量为5～10 ml/(kg·min)；B1组(颈内动脉狭窄度50％ ～70％)行DHCA、右腋动脉选择性脑灌注,灌注量为5～10 ml/(kg·min)；B2组(颈内动脉狭窄度50％～70％)行DHCA、右腋动脉选择性脑灌注,灌注量为10～ 15 ml/(kg·min)；C1组(颈内动脉狭窄度＞70％且合并脑基底动脉环狭窄)行DHCA、右腋动脉选择性脑灌注,灌注量为10 ～ 15 ml/(kg·min),C2组(颈内动脉狭窄度＞70％且合并脑基底动脉环狭窄)行DHCA、经右腋及左颈总动脉选择性脑灌注,灌注量为10～15 ml/( kg·min).结果 A组0例、B1组3例、B2组0例、C1组3例、C2组0例出现神经系统并发症.B2、C2组患者脑干听神经诱发电位明显低于B1、C1组(P均＜0.05).结论 采用全弓置换象鼻支架置人术治疗DebakeyI型主动脉夹层/瘤合并颈内动脉及基底动脉环狭窄时,适当增加DHCA灌注量和行双侧脑灌注,可保护脑功能.
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