Deep Hypothermic Circulatory Arrest In A Full Bow "Elephant Trunk" Technique In Different Perfusion Flow Selective Cerebral Perfusion For Brain Protection

Objective Explore the deep hypothermic circulatory perfusion flow selective cerebral perfusion on total arch replacement trunk stent implantation for treatment of cerebral protective effect of the artery and basilar artery stenosis ring the DeBakey the I aortic dissection combined with internal jugular.Methods46cases of DeBakey type I aortic dissection with carotid artery and the basilar artery ring stenosis, underwent total arch replacement trunk stenting. The patients were divided into A, B, C, three groups according to the degree of stenosis of the internal carotid and basilar artery rings. Perfusion and methods Patients were divided into A, B1, B2, C1, C2five groups. Group A and14cases (internal carotid artery stenosis<50%) simple deep hypothermic circulatory arrest (with DHCA) and selective cerebral perfusion of the right axillary artery perfusion for5～1Oml/(kg· min); Eight cases in group B1(carotid artery stenosis of50%～70%) line with DHCA and selective cerebral perfusion of the right axillary artery perfusion is5～10ml/(kg· min); B2,8cases (internal carotid artery stenosis50%～70%) of the line with DHCA, the right axillary artery, selective cerebral perfusion, perfusion of10～15ml/(kg·min); C1group8cases (internal carotid artery stenosis>70%stenosis) combined with cerebral basilar artery ring selective cerebral perfusion line with DHCA, the right axillary artery perfusion for10to15ml/(kg·min), C2,8cases (internal carotid artery stenosis>70%stenosis combined with cerebral basilar artery ring) line with DHCA, bilateral perfusion through the right axillary and left common carotid artery antegrade selective cerebral perfusion, perfusion for10to15ml/(kg· min). This study using brainstem auditory evoked potentials, Wechsler Memory Scale and the Glasgow coma scale to detect the function of the nervous system, study SPSS13.0software, using t tests and chi-square test for processing the data obtained, the comparative analysis of left and right ears, sex and age of measurement parameters. And a group of normal brainstem visual evoked potentials of the normal contrast.Results0cases, nervous system complications in group A, Bl,3cases, B2,0cases, three cases of group C1, C2,0cases. B2, C2group of patients with brain stem to listen to the evoked potential waveform change was significantly lower than B1, group C1(P<0.05), the measured values in B2, and C2groups Wechsler Memory Scale and Glasgow coma score was significantly higher than C1, C2(P<0.05). Using total arch replacement trunk stenting Debakey type I aortic dissection combined with internal carotid artery and basilar artery ring narrow, when the line right axillary artery unilateral selective cerebral perfusion DHCA perfusion5-10ml/kg·minevoked potentials in patients with waveform changes, the Wechsler Memory Scale measured value and the Glasgow coma score was significantly lower neurological complications increased significantly. When underwent selective bilateral brain perfusion or DHCA perfusion10-15ml/kg·min, evoked potentials in patients with no significant changes, the measured value of Wechsler Memory Scale and the Glasgow Coma Scale value, neurological complications incidencereduced.Conclusion1, the internal carotid artery stenosis <50%and does not merge basilar artery ring narrow, simple deep hypothermic circulatory arrest, selective cerebral perfusion the perfusion5-10ml/kg·min, to provide adequate perfusion of brain reduce the neurological complications.2, the internal carotid artery stenosis50%to70%and does not merge the basilar artery ring stenosis, the use of simple deep hypothermic circulatory arrest, selective cerebral perfusion, when the perfusion10-15ml/kg·min, can reduce the neurological complications.3, the internal carotid artery stenosis>70%with cerebral basilar artery ring narrow, selective bilateral brain perfusion can reduce the neurological complications the perfusion10-15ml/kg·min.