股动脉和腋动脉插管应用于主动脉弓部手术的结果比较
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摘要
目的比较股动脉和腋动脉插管在成人主动脉弓部手术中的应用及结果比较。方法选取行主动脉弓部手术患者58例,根据术中采用的插管方式分为股、腋动脉两组,分别记录两组患者一般情况、手术方式、体外循环转流时间、主动脉阻断时间、脑灌注时间、术后清醒时间、气管插管时间、重症监护室(intensive care unit,ICU)住院时间、术后心功能恢复、插管相关并发症和术后出现认知功能障碍等情况。结果两组共计3例患者死亡,其余患者均痊愈出院,两组患者一般情况及主动脉阻断时间股动脉组(113±18) min、腋动脉组(117±16) min;脑灌注时间股动脉组(25±6) min、腋动脉组(25±6) min、两组体外循环转流时间股动脉组(266±24) min、腋动脉组(267±24) min患者术后清醒时间股动脉组(37±26) h、腋动脉组(38±26) h;气管插管时间股动脉组(64±6) h、腋动脉组(63±7) h;重症监护室住院时间股动脉组(8.5±2.1) d、腋动脉组(8.1±2.2) d、休克的发生率、插管相关并发症发生率及术后出现认知功能障碍的差异均无统计学意义。结论股动脉和腋动脉插管对行主动脉弓部手术患者术后脑部并发症及插管相关并发症的发生无显著差异。
AIM To compare the outcomes between axillary and femoral artery cannulations in patients undergoing adult aortic arch surgery. METHODS A total of 58 patients undergoing surgery of the aortic arch between January 2015 and June 2016 were divided into an axillary group(n=31), in which the right axillary artery was cannulated and a femoral group(n=27) in which the femoral artery was cannulated. We recorded and compared between the two groups the patients' general conditions, cardiopulmonary bypass time, aortic clamping time, cerebral perfusion time, postoperative recovery time, tracheal intubation time, time stay in intensive care unit(ICU), postoperative heartfunction recovery, cannulation-related complications, and postoperative cognitive dysfunction. RESULTS Three patients died out of 58 patients and the other patients recovered and were discharged from the hospital. There were no differences between the two groups in aortic clamping time(113±18 vs. 117±16) minutes, cerebral perfusion time(25±6 vs. 25±6) minutes, cardiopulmonary bypass time(266±24 vs. 267±24) minutes, postoperative recovery time(37±26 vs. 38±26) hours, intubation time(64±6 vs. 63±7) hours, stay time in ICU(8.5±2.1 vs. 8.1±2.2) days, postoperative stoke, neurologic outcomes and cannulation-related complications. CONCLUSION There was no difference in postoperative neurologic outcomes and cannulation-related complications between axillary and femoral artery cannulations in aortic arch surgery. The cannulation site should be carefully chosen on a case-by-case basis and measures should also be taken to prevent intraoperative malperfusion syndrome.
AIM To compare the outcomes between axillary and femoral artery cannulations in patients undergoing adult aortic arch surgery. METHODS A total of 58 patients undergoing surgery of the aortic arch between January 2015 and June 2016 were divided into an axillary group(n=31), in which the right axillary artery was cannulated and a femoral group(n=27) in which the femoral artery was cannulated. We recorded and compared between the two groups the patients' general conditions, cardiopulmonary bypass time, aortic clamping time, cerebral perfusion time, postoperative recovery time, tracheal intubation time, time stay in intensive care unit(ICU), postoperative heartfunction recovery, cannulation-related complications, and postoperative cognitive dysfunction. RESULTS Three patients died out of 58 patients and the other patients recovered and were discharged from the hospital. There were no differences between the two groups in aortic clamping time(113±18 vs. 117±16) minutes, cerebral perfusion time(25±6 vs. 25±6) minutes, cardiopulmonary bypass time(266±24 vs. 267±24) minutes, postoperative recovery time(37±26 vs. 38±26) hours, intubation time(64±6 vs. 63±7) hours, stay time in ICU(8.5±2.1 vs. 8.1±2.2) days, postoperative stoke, neurologic outcomes and cannulation-related complications. CONCLUSION There was no difference in postoperative neurologic outcomes and cannulation-related complications between axillary and femoral artery cannulations in aortic arch surgery. The cannulation site should be carefully chosen on a case-by-case basis and measures should also be taken to prevent intraoperative malperfusion syndrome.
引文
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[8] Schachner T,Nagiller J,Zimmer A,et al.Technical problems and complications of axillary artery cannulation[J].Eur J Cardiothorac Surg,2005,27(4):634-637.
[9]Sabik JF,Nemeh H,Lytle BW,et al.Cannulation of the axillary rtery with a side graft reduces morbidity[J].Ann Thorac Surg,2004,77(4):1315-1320.
[10]Lee HK,Kim GJ,Cho JY,et al.Comparison of the Outcomes between Axillary and Femoral Artery Cannulation for Acute Type A Aortic Dissection[J].Korean J Thorac Cardiovasc Surg,2012,45(1):85-90.
[2] Gulbins H,Pritisanac A,Ennker J.Axillary versus femoral cannulation for aortic surgery:enough evidence for a general recommendation?[J].Ann Thorac Surg,2007,83(3):1219-1224.
[3] Shimokawa T,Takanashi S,Ozawa N,et al.Management of intraoperative malperfusion syndrome using femoral artery cannulation for repair of acute type A aortic dissection[J].Ann Thorac Surg,2008,85(5):1619-1624.
[4] Moizumi Y,Motoyoshi N,Sakuma K,et al.Axillary artery cannulation improves operative results for acute type a aortic dissection[J].Ann Thorac Surg,2005,80(1):77-83.
[5] Fusco DS,Shaw RK,Tranquilli M,et al.Elefteriades JA.Femoral cannulation is safe for type A dissection repair[J].Ann Thorac Surg,2004,78(4):1285-1289.
[6] Hedayati N,Sherwood JT,Schomisch SJ,et al.Axillary artery cannulation for cardiopulmonary bypass reduces cerebral microemboli[J].J Thorac Cardiovasc Surg,2004,128(3):386-390.
[7] Pacini D,Leone A,Di Marco L,et al.Antegrade selective cerebral perfusion in thoracic aorta surgery:Safety of moderate hypothermia[J].Eur J Cardiothorac Surg,2007,31(4):618-622.
[8] Schachner T,Nagiller J,Zimmer A,et al.Technical problems and complications of axillary artery cannulation[J].Eur J Cardiothorac Surg,2005,27(4):634-637.
[9]Sabik JF,Nemeh H,Lytle BW,et al.Cannulation of the axillary rtery with a side graft reduces morbidity[J].Ann Thorac Surg,2004,77(4):1315-1320.
[10]Lee HK,Kim GJ,Cho JY,et al.Comparison of the Outcomes between Axillary and Femoral Artery Cannulation for Acute Type A Aortic Dissection[J].Korean J Thorac Cardiovasc Surg,2012,45(1):85-90.