目的 总结应用三分支支架血管重建全主动脉弓治疗急性A型主动脉夹层的体外循环方法.方法 2008年6月至2009年11月,对30例StanfordA型主动脉夹层患者行升主动脉人造血管替换加三分支支架血管置入,术中采用深低温停循环及选择性脑灌注的体外循环方法.结果 30例患者平均体外循环时间(151.8±16.69)min、心肌缺血时间(84.1±6.97)min、平均选择性脑灌注时间(40.85±3.13)min,平均下半身停止灌注时间(31.17±5.34)min,平均全身停循环时间(2.6±1.09)min.术后转入重症监护病房6小时内全部清醒,无神经系统并发症.平均机械辅助通气时间(17.93±2.35)h,平均重症监护病房观察时间(62.10±9.24)h.目前定期门诊随访中,无死亡和需要再次手术病例.结论 应用三分支支架血管重建全主动脉弓治疗急性A型主动脉夹层术中采用深低温停循环及选择性脑灌注的体外循环方法是安全有效的.%Objective To summary the cardiopulmonary bypass experience of Stanford type A aortic dissection underwent extensive primary repair of the thoracic aorta by means of ascending aorta replacement combined with triple-branched stent graft. Methods Between June 2008 and November 2009, 30 patients with acute Stanford type A aortic dissection underwent extensive primary repair of the thoracic aorta by means of ascending aorta replacement combined with triple-branched stent graft. The operations were all performed under general anesthesia, and carried out under deep hypothermia with circulatory arrest and selected cerebral perfu-sion. Results The mean cardiopulmonary bypass time was (151. 8 ± 16. 69) minutes. The mean aortic cross-clamp time was (84. 1 ± 6. 97) minutes. The mean selective cerebral perfusion was (40. 85 ±3. 13) minutes. The mean lower-body arrest time was (31. 17 ± 5. 34) minutes. The mean whole body arrest time was (2. 6 ± 1. 09) minutes. All patients were successfully treated without neurologic complication. The mean postoperative mechanical ventilation support period and mean duration of intensive care unit stay were (17. 93 ±2. 35) and (62. 10 ±9. 24) hours, respectively. Currently 30 patients were on regular follow-up. No death occurred and no cases needed reoperation. Conclusions The therapy of artificial blood vessel replacement and total arch grafting with triple-branched stent graft is safe. The technique of using selected cerebral perfusion in cerebral protection is safe and effective during deep hypothermic circulatory arrest.
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