Abstract:

Maintaining optimal cerebral perfusion during cardiopulmonary bypass and circulatory arrest is basis of intraoperative management of aortic arch surgery. Various cerebral protection techniques including hypothermia, cerebral perfusion, drug protection and blood gas management have been used in the clinic, but the optimal strategy remains difficult to determine. The clinical outcome of cerebral protection in aortic arch surgery largely depends on brain temperature, circulatory arrest time and cerebral perfusion at the time of circulatory arrest. The optimal brain protection strategy should be individualized treatment on the basis of comprehensive brain monitoring, so as to effectively reduce the occurrence of brain injury. This article summarizes the means or indicators of brain monitoring and management during cardiopulmonary bypass in aortic arch surgery, as well as perioperative brain protection strategies, in order to guide the clinical practice of intraoperative brain protection in aortic arch surgery.

Key words: Aorta, thoracic, Extracorporeal circulation, Cardiovascular surgical procedures, Perioperative period, Review

摘要：

体外循环和停循环下维持最佳脑灌注是主动脉弓部手术中脑保护的基础。脑保护策略包括低温、脑灌注、药物治疗和血气管理，已应用于临床，但最佳策略仍难确定。主动脉弓部手术中脑保护的临床结局在很大程度上取决于脑温、停循环时间和脑灌注类型，最佳的脑保护策略应是在全面脑监测的基础上进行个体化治疗，有效减少脑损伤。本文总结体外循环下主动脉弓部手术脑监测与管理方法或指标以及围手术期脑保护策略，以指导主动脉弓部手术中脑保护的临床实践。

关键词: 主动脉, 胸, 体外循环, 心血管外科手术, 围手术期, 综述