Brain damage after aortic arch repair using selective cerebral perfusion.
Brain damage after aortic arch repair using selective cerebral perfusion.
复制标题
使用选择性脑灌注修复主动脉弓后的脑损伤。
DOI：
10.1016/s0003-4975(98)00587-6
复制
发表时间：
1998
期刊：
影响因子：
--
通讯作者：
H. Saito
中科院分区：
文献类型：
--
作者：
M. Ohmi;K. Tabayashi;M. Hata;H. Yokoyama;M. Sadahiro;H. Saito
背景选择性脑灌注是主动脉弓修复术中最常用的脑保护方法之一。然而，术后脑损伤的原因还不完全清楚。我们分析了脑损伤主动脉弓修复后，使用选择性脑灌注真正的主动脉弓动脉瘤方面的术前脑梗死和颅内外闭塞性arterial diseases.MethodsOver 9年的时间，60例患者与真正的主动脉弓动脉瘤进行主动脉弓修复使用选择性脑灌注。术后脑损伤进行了评估，在术前脑梗死检测计算机断层扫描，磁共振成像，或两者在50例和颅内和颅外闭塞性动脉疾病检测数字减影血管造影，磁共振血管造影，或两者在35 patients.Results7（12%）的60例患者在30天内死亡的操作。57例患者中有6例（10.5%）发生了术后脑损伤（3例昏迷，3例偏瘫）;排除了3例未苏醒死亡的患者。术前发现陈旧性脑梗死9例（18%），无症状性脑梗死（腔隙性脑梗死和脑白质疏松）26例（52%）。9例术前脑梗死患者中有3例（33%）发生了术后脑损伤，13例术前脑检查结果阴性的患者中有3例（23%）发生了术后脑损伤;这不包括2例未醒来死亡的患者。无症状脑梗死患者术后均未出现脑损伤。7例患者（20%）检测到闭塞性动脉疾病。无症状性脑梗死的发生率为71%（5/7），明显高于无闭塞性动脉病变的患者4%（1/28）（P < 0.001）。术前评估颅内和颅外动脉闭塞性疾病提供了重要的信息，患者是否可能维持脑损伤后主动脉弓修复术使用选择性脑灌注。
BackgroundSelective cerebral perfusion is one of the most popular methods for cerebral protection during aortic arch repair. However, causes of postoperative brain damage are not fully understood. We analyzed brain damage after aortic arch repair using selective cerebral perfusion for true aortic arch aneurysm in regard to preoperative cerebral infarction and intracranial and extracranial occlusive arterial disease.MethodsOver a 9-year period, 60 patients with true aortic arch aneurysm underwent aortic arch repair using selective cerebral perfusion. Postoperative brain damage was evaluated in regard to preoperative cerebral infarction detected by computed tomography, magnetic resonance imaging, or both in 50 patients and intracranial and extracranial occlusive arterial disease detected by digital subtraction angiography, magnetic resonance angiography, or both in 35 patients.ResultsSeven (12%) of the 60 patients died within 30 days of operation. Postoperative brain damage occurred in 6 (10.5%) (3, coma, and 3, hemiplegia) of 57 patients; 3 patients who died without awakening were excluded. Preoperatively, old cerebral infarction was detected in 9 patients (18%), and silent cerebral infarction (lacunar infarction and leukoaraiosis) was diagnosed in 26 patients (52%). Postoperative brain damage occurred in 3 (33%) of the 9 patients with preoperative cerebral infarction and in 3 (23%) of 13 patients with negative preoperative brain findings; this excludes 2 patients who died without awakening. No patient with silent cerebral infarction had postoperative brain damage. Occlusive arterial disease was detected in 7 patients (20%). The incidence of brain damage in these patients was 71% (5/7), which was significantly greater than that of 4% (1/28) in patients without occlusive arterial disease (p < 0.001).ConclusionsSilent cerebral infarction may not be a risk factor for postoperative brain damage. Preoperative evaluation of intracranial and extracranial occlusive arterial disease provides important information as to whether a patient might sustain brain damage after aortic arch repair using selective cerebral perfusion.