The physiology of hypothermic circulatory arrest.
The physiology of hypothermic circulatory arrest.
复制标题
低温停循环的生理学。
DOI：
10.5555/uri:pii:104306799190007t
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发表时间：
1991
影响因子：
2.5
通讯作者：
G. Pogo
中科院分区：
文献类型：
--
作者：
Randall B. Griepp;M. Ergi̇n;S. Lansman;J. Galla;G. Pogo
本次演讲的标题雄心勃勃，名为“低温停循环的生理学”，但这显然不是一个可以在如此短的时间内全面涵盖的主题。我们希望谈谈一些具有实际重要性的观点，并讨论我们最近在体温过低方面的一些经验。表 1 概述了在动脉瘤手术中使用低温停循环 (HCA) 的推动力。HCA 极大地简化了主动脉弓手术，并且确实使常规手术成为可能。正如 Cooley 博士在本期其他地方所指出的那样，HCA 在升主动脉置换术中使用开放技术进行远端吻合是安全的，我们相信它肯定会提高最终手术的质量。最后，当放置近端夹钳不可行时，HCA 可用于胸降主动脉手术，因为弓部充满动脉粥样化碎片、存在钙化，或者动脉瘤本身实际上延伸回弓部。在这种情况下，使用深度低温可以使本来不可能的手术变得现实。尚未解答的主要问题是这种技术对大脑的保护效果如何。”在心脏手术的许多领域，随着我们的结果不断提高，有关我们在手术过程中所做的事情的长期后果的问题变得越来越重要。关注细节是任何技术获得最佳结果的基本策略，对于 HCA 期间的脑保护来说可能也是如此。我们必须继续批判性地审视我们的结果，看看我们的表现的各个方面是否可以改进。
This presentation is ambitiously entitled “The Physiology of Hypothermic Circulatory Arrest,” but this is obviously not a topic that can be covered comprehensively in so short a time. We hope to touch on a few points that are of practical importance, and also to discuss some of our recent experience with hypothermia. The impetus for the use of hypothermic circulatory arrest (HCA) in aneurysm surgery is outlined in Table 1. HCA very much simplifies procedures on the aortic arch, and indeed makes the operations routinely possible. As Dr Cooley has indicated elsewhere in this issue, HCA makes the use of the open technique for distal anastomosis in ascending aortic replacement safe, and we believe it definitely improves the quality of the final operation. Finally, HCA can be used in surgery of the descending thoracic aorta when putting the proximal clamp on is just not feasible, either because the arch is full of atheromatous debris, there is calcification, or the aneurysm itself actually extends back onto the arch. In such cases, the use of profound hypothermia makes an otherwise impossible operation realistic. The major unanswered question concerns how well this technique protects the brain.’ In many areas of cardiac surgery, as our results improve, questions regarding the long-term consequences of what we are doing during the operation have become increasingly important. Paying attention to the details is an essential strategy for achieving an optimal result with any technique, and it is likely to be true with regard to cerebral protection during HCA. We must continue looking critically at our results to see whether various features of our performance could, perhaps, be improved.