·8··临床研究论著·中国胸心血管外科临床杂志2005年2月第12卷第1期ChinJClinThoracrdi!!!曼:!!!!!!:!!::2:单侧与双侧顺行性脑灌注对认知能力的影响田良鑫孙立忠程卫平杨九光郑军刘宁宁(中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院血管外科中心,北京100037)摘要:目的比较全主动脉弓置换术中应用单侧顺行性脑灌注和双侧顺行性脑灌注对认知能力的影响。方法16例全主动脉弓置换术患者按随机数字表法随机分为单侧顺行性脑灌注组和双侧顺行性脑灌注组,每组各8例。两组均行术前、术后神经系统物理检查、颅脑计算机体层摄影(CT)和认知能力测验比较。结果无手术及近期死亡,无新发脑梗塞出现。两组各有1例出现短暂性神经功能异常,两组间术前和术后的认知能力比较差别无统计学意义(P>O.05)。结论在基底动脉环完整、存在有效侧枝循环的条件下,单侧顺行性脑灌注及双侧顺行性脑灌注均能取得良好的效果,两种脑保护方法对认知能力的影响无统计学意义。关键词:脑血管循环;全主动脉弓置换术;单侧顺行性脑灌注;双侧顺行性脑灌注;神经心理学测验中图分类号:R654.1;R654.3文献标识码:A文章编号:1007—4848(2005)01—0008—03ProspectiveRandomisedNeuroc0gnitiVeStudyofUnilateralandBilateralAntegradeSelectiveCerebralPerfusionforTotalAorticArchReplacement7’,AⅣLiangxin,SUNLi—zhong,CHENGWei—ping,YANGtliuguang,ZHENG.IunIIUNing—ning.(DepartmentofCardiac’Surgery,Cardiovasc’ularInstituteandFuwaiHospital,ChineseAcademyofMedical5cl'eHceS8PekingUnionMedicalCollege,Beijing100037,P.R.China)Abstract:ObjectiveTocomparethecerebralprotectiveeffectofunilateralandbilateralantegradeselectivecerebralperfusionduringtotalaorticarchreplacement,particularlywithrespecttOneuropsychologicaloutcome.MethodsFromJune2003tOMarch2004,16patientswhounderwenttotalaorticarchreplacementwererandomlyallocatedtooneoftwomethodsofbrainprotection:unilateralantegradeselectivecerebralperfusion(unilateralgroup,n一8)orbilateralantegradecerebralperfusion(bilateralgroup,n一8).Preoperativeandpostoperativeneurologicalexamination,braincomputedtomography(CT)scan,andcognitivefunctiontestswereperformed.ResultsAllpatientssurvivedtheoperationsandweredischargedfromhospita1.Nonewbraininfarctionoccurred.Transientneurologicdysfunctionoccurredin1patientofeachgroup.Therewerenointergroupdifferencesinthescoresofpreoperativeandpostoperativecognitivefunction(P>0.05).ConclusionBothmethodsofbrainprotectionforpatientsundergoingtotalaorticarchreplacementresultinfavorableandsimilareffectofbrainprotectionintermofcognitivefunctionprovidedthecircleofWillisispatentandcollateralflowisadequate.Keywords:Cerebrovascularcirculation;Totalaorticarchreplacement;Unilateralantegradeselectivecerebralperfusion;Bilateralantegradecerebralperfusion;NeuropsychologicaltestFoundationitem:TheTenthFive—yearKeyTaskPlanforScienceandTechnology(2001BA705B10-7)中枢神经系统损伤一直是主动脉弓部手术中最突出的并发症和致死因素,深低温停循环技术曾广泛地应用于主动脉弓部手术中,但中枢神经耐受缺血的能力限制了停循环的安全时限。逆行性脑灌注(RCP)及选择性顺行性脑灌注(ASCP)便先后被用于主动脉弓部手术对脑的保护。对于两种灌注方法孰优孰劣尚有争议,但随着研究的进一步深入,有报道RCIb不能提供足够的营养物质,越来越多的学者采用顺行性脑灌注代替逆行性脑灌注用于主动脉弓部手术中的脑保护]。顺行性脑灌注可分为单侧顺行性脑灌注及双~u]JaDe,行性脑灌注两类。双侧顺行性脑灌注管道多,影响术野显露,且操作复杂。单侧顺行性脑灌注操作简便,但能否达到双侧顺行性脑灌注的脑保护效果基金项目:“十五”攻关项目(2001BA705B10-7)尚无定论。为此,...