Japanese
Title弓部大動脈再建術における脳合併症対策 ―体外循環中の脳循環モニタリングの意義―
Subtitle特集 シンポジウム1「脳と循環」
Authors青見茂之*, 八巻文貴*, 坂橋弘之*, 平井雅也*, 斎藤聡*, 橋本明政*, 小柳仁*, 野村稔**, 近藤泉**, 長沢千奈美**, 鈴木英弘**
Authors(kana)
Organization*東京女子医科大学循環器外科, **東京女子医科大学麻酔科
Journal循環制御
Volume16
Number3
Page291-296
Year/Month1995/
Article報告
Publisher日本循環制御医学会
Abstract「はじめに」心臓血管外科領域における脳合併症の発生は, 近年の体外循環技術の向上により大動脈の形状が良く弓部3分枝や脳血管に狭窄や閉塞がない症例においてはほとんど認められず, 通常の開心術における脳循環は問題ないと思われる. しかし, 最近の症例の高齢化により術前に脳血管障害の合併を多く認めるようになり, 適応が問題となっている. 我々は体外循環中の脳循環の指標として, 経頭蓋ドップラー法(TCD), 内頸静脈酸素飽和度(SjO2), 体性感覚誘発電位(SEP)などを用いて行っており成績向上を得ることが出来た. 今回は, 脳循環が最も重要となる弓部大動脈瘤手術における脳保護法の時代的変遷と, 成績向上をもたらした脳循環モニタングの方法と意義について述べた. 「対象および方法」1985年以降に弓部大動脈の再建術を行った95例を対象とした. 対象を脳灌流法により前期(1985〜1990年)の超低体温併用選択的脳灌流法(SCP)を用いた33例(I群)と後期(1990〜94年)の超低体温併用逆行性脳灌流法(RCP)用いた62例に分けた(図1).
Practice基礎医学・関連科学
Keywords
English
TitleBrain Protection in Aortic Arch Surgery Importance of Monitoring of Brain
Subtitle
AuthorsShigeyuki Aomi, Fumiaki Yamaki, Hiroyuki Sakahashi, Masaya Hirai, Saitou Hisashi, Akimasa Hashimoto, Hitoshi Koyanagi, Minoru Nomura*, Izumi Kondou*, Chinami Nagasawa*, Hidehiro Suzuki*
Authors(kana)
OrganizationDepartment of Cardiovascular Surgery, Tokyo Women's Medical College, *Department of Anesthesiology, Tokyo Women's Medical College
JournalCirculation Control
Volume16
Number3
Page291-296
Year/Month1995/
ArticleReport
PublisherJapan Society of Circulation Control
AbstractBetween March 1985 and December 1994, 95 patients underwent reconstruction of aortic arch aneurysm. From 1985 to 1990, we used the selective cerebral perfusion (SCP) for brain protection in 33 cases. However, there were 8 cases (24.2%) of major postoperative complications involving the brain, so we changed the technique of brain protection to retrograde cerebral perfusion (RCP) through the superior vena cava from October 1990. In the initial 29 cases, the conditions of RCP were high perfusion pressure (<30 cm H2O) and high flow rate (>300 ml/min). Using RCP, major complications involving the brain decreased to one case (3.4 %), but minor complications were observed in 7 cases ：double vision in 2 cases, tremor in 1 case and transient drowsiness in 4 cases in which RCP used forover 80 min. We measured cerebral blood flow using transcranial doppler (TCD) method during RCP in 7 cases, but in only 4our cases was cerebral blood flow detected and the velocity varied in each case from 10 to 50 % of the velosity before cardiopulmonary bypass. In a case in which RCP was used for over 80 min, cerebral blood flow during RCP gradually decreased and finally disappeared. These data and clinical symptoms showed hypoxia and mild edema of the brain in cases in which RCP over 80 min. Hence, we modifid the conditions of RCP to low perfusion pressure (<20 cm H2O) and low flow rate and limited the perfusion time of RCP to less than 80 min. In the remaining 33 cases, there were no minor complications and 3 major complication (9 %)：one case had old cerebral infarctions two time before and other 2 cases were acute dissection and cardiogenic schock. In conclusions, in surgical treatment of the aortic arch aneurysm RCP reduced cerebral complications. The measurement of cerebral blood flow using TCD during RCP was effective in determining the opimal conditions of RCP.
PracticeBasic medicine
Keywords

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