RETROGRADE AORTIC DISSECTION DURING CARDIOPULMONARY BYPASS
RETROGRADE AORTIC DISSECTION DURING CARDIOPULMONARY BYPASS
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DOI：
10.1002/clc.4960040610
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发表时间：
1981-01-01
影响因子：
2.7
通讯作者：
STEMMER, EA
中科院分区：
文献类型：
--
作者：
EUGENE, J;ARONOW, WS;STEMMER, EA
对于再次手术、涉及胸主动脉的手术和危重患者的部分搭桥手术，体外循环仍采用股动脉灌注。逆行主动脉夹层是股动脉灌注最重要的并发症。报告发病率为0.7-14%，死亡率为66%。大多数死亡发生在夹层未被识别的患者，或夹层被识别但未得到适当治疗的患者。本文报告640例(0.9%)股动脉回流逆行夹层6例的治疗经验。6名患者中有4人在夹层中存活下来。体外循环开始后不久，体外循环压力突然升高，静脉回流减少，径动脉压降低，突然出现蓝色隆起的升主动脉，这就确立了诊断。如果及时停止体外循环，建立主动脉插管，并在诱导深度低温的情况下重新建立旁路，可以提高存活率。然后可以采用循环停搏来修复假通道。在本系列中，6例患者均完成了拟议的手术。
Femoral artery perfusion for cardiopulmonary bypass is still employed for reoperation, procedures involving the thoracic aorta and partial bypass in critical patients. Retrograde aortic dissection is the most significant complication of femoral perfusion. The reported incidence is from 0.7-14% with a mortality of 66%. Most of the deaths occurred in patients in whom the dissection was not recognized, or in whom the dissection was recognized but not treated appropriately. Experience with retrograde dissection in 6 patients of 640 (0.9%) in whom femoral inflow was used is reported. Four of the 6 patients survived the dissection. Sudden increase in extracorporeal line pressure shortly after beginning cardiopulmonary bypass associated with decreased venous return, dampened radial arterial pressure and the abrupt appearance of a bluish, bulging ascending aorta establishes the diagnosis. Survival is enhanced if cardiopulmonary bypass is promptly discontinued, aortic cannulation established and bypass reinstituted with the induction of profound hypothermia. Circulatory arrest may then be employed to repair the false passage. In this series the proposed operation was completed in all 6 patients.