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首页> 外文期刊>Journal of cardiac surgery. >Aortic arch reconstruction: safety of moderate hypothermia and antegrade cerebral perfusion during systemic circulatory arrest.
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Aortic arch reconstruction: safety of moderate hypothermia and antegrade cerebral perfusion during systemic circulatory arrest.

机译：主动脉弓重建：中度体温过低和系统性循环停搏期间顺行性脑灌注的安全性。

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Background and Aim: The ideal strategy for cerebral protection during aortic arch (AA) reconstructive surgery remains undefined. Antegrade cerebral perfusion (ACP) during systemic circulatory arrest (SCA) may provide superior results; however, optimal systemic temperature is undetermined. Our objective was to determine whether "deep" hypothermia is necessary during ACP with SCA, and whether the degree of hypothermia is associated with neurologic outcomes postoperatively. Methods: Retrospective series of 72 consecutive patients (aged 65.9 +/- 3.2 years) who underwent AA reconstructive surgery at Vancouver General Hospital using a cerebral protection strategy of ACP with SCA between December 1995 and December 2002. Patients were divided into two groups according to lowest systemic temperature: <22 degrees C (n = 52) and >/=22 degrees C (n = 20). Results: ACP was via right axillary or innominate artery, +/- left common carotid cannulation. Median SCA time with ACP was not different between groups. There were four hospital deaths (5.6%) (three from the <22 degrees C group). Eight patients (11.2%) had major neurologic injuries (seven from the <22 degrees C group): 4 (5.6%) permanent (1 fatal) and 4 (5.6%) temporary. There was a trend toward a significantly higher incidence of delirium in the <22 degrees C group than the >/=22 degrees C group (30.8 vs 10.0%, respectively, p = 0.07). Conclusions: In our experience, SCA with ACP was a safe technique for AA reconstructive surgery. The observation of a larger number of major neurologic injuries, and a trend toward a higher incidence of delirium in the <22 degrees C group, suggests that systemic temperatures below 22 degrees C may not be necessary and may be associated with a higher incidence of neurologic injury when using ACP during SCA.
机译：背景与目的：在主动脉弓（AA）重建手术中进行脑保护的理想策略尚不确定。全身循环骤停（SCA）期间的整体脑灌注（ACP）可能会提供更好的结果;但是，最佳系统温度尚未确定。我们的目标是确定在进行SCA的ACP期间是否需要进行“深层”低温治疗，以及低温程度是否与术后神经系统预后相关。方法：回顾性分析了1995年12月至2002年12月在温哥华总医院采用ACP和SCA的脑保护策略行AA重建手术的72例连续患者（年龄65.9 +/- 3.2岁）。根据年龄不同，患者分为两组最低系统温度：<22摄氏度（n = 52）和> / = 22摄氏度（n = 20）。结果：ACP经由右腋窝或无名动脉，+ /-颈总颈插管。各组之间ACP的SCA中位时间无差异。有4例医院死亡（5.6％）（<22度C组中有3例）。八名患者（11.2％）受到了严重的神经系统损伤（<22度C组中的七名）：4（5.6％）永久性（1致命）和4（5.6％）临时性。 <22°C组than妄发生率明显高于> / = 22°C组（妄发生的趋势（分别为30.8和10.0％，p = 0.07）。结论：根据我们的经验，SCA与ACP是AA重建手术的安全技术。在<22摄氏度的人群中观察到大量的重大神经系统损伤以及a妄发生率呈上升趋势，这表明低于22摄氏度的全身温度可能不是必需的，并且可能与神经系统发生率较高相关在SCA中使用ACP时受伤。

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