弓部大動脈再建における脳保護の検討

フォーマット:

論文

責任表示:

榊原, 直樹 ; 浦山, 博 ; 松永, 康弘 ; 竹村, 博文 ; 村上, 眞也 ; 上山, 圭史 ; 川筋, 道雄 ; 渡辺, 洋宇 ; Sakakibara, Naoki ; Urayama, Hiroshi ; Matsunaga, Yasuhiro ; Takemura, Hirofumi ; Murakami, Shinya ; Ueyama, K. ; Kawasuji, Michio ; Watanabe, Yoh

言語:

日本語

出版情報:

日本心臓血管外科学会 = The Japanese Society for Cardiovascular Surgery / 南江堂, 1993-07

著者名:

榊原, 直樹

浦山, 博

松永, 康弘

竹村, 博文

村上, 眞也

上山, 圭史

川筋, 道雄

渡辺, 洋宇

Sakakibara, Naoki

Urayama, Hiroshi

Matsunaga, Yasuhiro

Takemura, Hirofumi

Murakami, Shinya

Ueyama, K.

Kawasuji, Michio

Watanabe, Yoh

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掲載情報:

胸部外科 = 日本心臓血管外科学会雑誌 = The Japanese journal of thoracic surgery

ISSN:

0021-5252      

巻:

46

通号:

8 Suppl

開始ページ:

648

終了ページ:

651

バージョン:

publisher

概要:

金沢大学医薬保健研究域医学系<br />We analyzed cerebral protection of twenty-five patients, 11 of whom underwent ascending-arch aortic replacement and 14 underwent aortic arch replacement, supported with cardiopulmonary bypass. Twenty of patients un … derwent selective cerebral perfusion (SCP) with moderate hypothermic circulatory support; 12 of single SCP, 8 of double SCPs. Major arch branch reconstruction were performed with 11 patients; 3 of triple branches, 2 of double branches and 6 of single branch reconstruction. Cerebral impairment was found in 7 patients (25%) with SCP; 3 of them died of low output syndrome and major bleeding during perioperative period. Four of 17 patients, who survived more than one month, showed cerebral infarction in 2 patients and temporary neurological deficit in 2 patients. Our strategies for cerebral protection are (1) careful cerebral four vessels study, (2) SCP with perfusion pressure more than 40 mmHg and flow rate of 7-10 ml/kg/min under moderate hypothermia, (3) bilaterally double branches perfusion minimally for arch replacement, (4) intensive cerebral monitoring from multiple aspect, (5) pharmacological support with barbiturate or aprotinin, (6) gentle maneuver and reliable major branch cannulation to prevent debris embolism. 続きを見る

URL:

http://hdl.handle.net/2297/00050829