| Objective: To summarize the brain protection strategy of super-weight patients with acute Stanford type A aortic dissection under deep hypothermic circulatory arrest,providing a standard for selective cerebral perfusion in super-weight patients.Methods: Selecting the Department of Cardiology,the First Affiliated Hospital of China Medical University,from January 2018 to January 2019,32 patients with acute Stanford type A dissection treated with Sun’s surgery(aortic arch replacement and elephant trunk surgery)were divided into two groups according to their body weight.The group of super-weight(group H,body weight >95kg,n=12),normal body group(G group,70kg<body weight <85kg,n=20);group H according to [5~6 ml/(min·kg)brain perfusion was performed,and group G was perfused with [6~8 ml/(min·kg)].CT images of preoperative patients with thin-layer brain were collected.Mimics software was used to reconstruct brain tissue,brain volume was measured,and brain volume and brain volume were correlated with body weight.The NIRS probe was used at 6 time points(T1 after anesthesia induction,Blocking the aorta T2,deep hypothermic circulatory arrest T3,rewarming to 30 °C T4,rewarming to 35 °C T5 and T6 after cardiopulmonary bypass)measured and recorded regional cerebral oxygenation(rSc02);At the same time,the blood in the internal jugular vein and the aortic perfusion tube were collected at six time points for blood gas analysis,and the arteriovenous oxygen partial pressure(Pa02,Pjv02),arteriovenous oxygen saturation(Sa02,Sjv02),hemoglobin(HB),lactic acid were measured.(Lac),and calculate CI,arteriovenous oxygen content(Ca02,Cjv02),cerebral oxygen supply(DO2),cerebral oxygen consumption(VO2),cerebral oxygen uptake rate(CER02);use simple intelligent mental state evaluation scale(mini-mental state examination,MMSE)Cognitive function assessment was performed 1 day before surgery and 1 week after surgery,and the incidence of postoperative delirium was assessed using the ICU Screening(ICDSC)checklist.Through the above methods,the clinical effect of perfusion of brain volume during selective cerebral perfusion during deep hypothermic circulatory arrest in patients with overweight was evaluated.Results: 1.One patient in group H had severe transient mental disorder after operation,and returned to normal consciousness about 2 weeks after surgery.The remaining patients did not have severe neurological complications;2.There was no significant difference in brain volume between the two groups(P>0.05).There was no correlation between brain volume and body weight(r=0.027 P=0.882>0.05);3.During the time between groups,there was no significant difference in rSc02 between the two groups(P>0.05);4.There was no significant difference in DO2,VO2,Sjv02,CER02 and Lac between the time points(P>0.05);5.Preoperative and surgical There were no significant differences between the groups of MMSE cognitive function scores and groups(P>0.05),and there was no significant difference between the two groups(P>0.05).Conclusion: 1.The brain volume was basically the same between the two groups of patients,and the brain volume did not change with the change of body weight;2.In the two groups,although there were significant differences in body weight,there was no significant difference in brain metabolism levels;3.Overweight patients,DHCA+ASCP period According to the brain volume,the cerebral perfusion flow can be appropriately reduced,that is,perfusion according to [5~6 ml/(min·kg)] can provide sufficient blood flow to the brain to meet the cerebral oxygen metabolism,without increasing postoperative neurological complications. |
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