PDF(Pubmed)
Abstract：
Complex ascending and aortic arch surgery requires the implementation of different cerebral protection strategies to avoid or limit the probability of intraoperative brain damage during circulatory arrest. The etiology of the damage is multifactorial, involving cerebral embolism, hypoperfusion, hypoxia and inflammatory response. These protective strategies include the use of deep or moderate hypothermia to reduce the cerebral oxygen consumption, allowing the toleration of a variable period of absence of cerebral blood flow, and the use of different cerebral perfusion techniques, both anterograde and retrograde, on top of hypothermia, to avoid any period of intraoperative brain ischemia. In this narrative review, the pathophysiology of cerebral damage during aortic surgery is described. The different options for brain protection, including hypothermia, anterograde or retrograde cerebral perfusion, are also analyzed, with a critical review of the advantages and limitations under a technical point of view. Finally, the current systems of intraoperative brain monitoring are also discussed.
摘要：
复杂的升和主动脉弓手术需要实施不同的脑保护策略，以避免或限制循环停止期间术中脑损伤的可能性。损害的病因是多因素的，涉及脑栓塞,灌注不足,缺氧和炎症反应。这些保护策略包括使用深度或中度低温来减少脑氧消耗，允许耐受不同时期的脑血流缺失，使用不同的脑灌注技术，顺行和逆行,除了体温过低，避免任何时期的术中脑缺血。在这篇叙述性评论中，描述了主动脉手术中脑损伤的病理生理学。大脑保护的不同选择，包括体温过低,顺行或逆行脑灌注,也被分析，从技术角度对优点和局限性进行了严格的审查。最后,还讨论了当前的术中脑部监测系统。
