Objective To investigate the impact of different modes of cardiopulmonary bypass （CPB） and cerebral perfusion on cerebral protection in patients with Stanford type A aortic dissection （AD）. Methods Clinical data of 117 patients with Stanford type A AD who underwent surgical therapy from April 2007 to March 2012 in the First Affiliated Hospital of Harbin Medical University were retrospectively analyzed. All the patients were divided into 3 groups according to different modes of CPB and cerebral perfusion they received. In group 1，45 patients received CPB perfusion through the femoral artery and unilateral or bilateral antegrade selective cerebral perfusion （ASCP） after circulatory arrest. In group 2，38 patients received CPB perfusion through the subclavian artery or innominate artery and unilateral or bilateral ASCP after circulatory arrest. In group 3，34 patients received antegrade and retrograde CPB perfusion through both subclavian artery or innominate artery and femoral artery，and unilateral or bilateral ASCP after circulatory arrest. Postoperative occurrence of transient neurological dysfunction （TND），permanent neurological dysfunction （PND） and influential factors were compared between the 3 groups. Results Incidence of postoperative cerebral complications of group 1 was significantly higher than those of group 2 and 3 （37.77% vs. 13.16% vs. 14.71%，P ＜0.05）. During CPB，cooling time of group 3 was significantly shorter than those of group 1 and 2 （35.56±4.35 vs. 40.00±5.63 and 39.58±6.03，P ＜0.05）. There was no statisticaldifference in other influential factors among the 3 groups （P ＞0.05）. Conclusion Antegrade and retrograde CPB perfusionin combination with ASCP has a smooth and quicker cooling rate，may provide better protection for the spinal cord，kidney and intraperitoneal organs and especially decrease the incidence of postoperative cerebral complications，therefore is proved current best method for organ protection.
目的 探讨糖尿病对主动脉壁内血肿的预后影响。 方法 纳入 2012 年 10 月至 2014 年 11 月我院连续 24 例主动脉壁内血肿患者，其中男 17 例、女 7 例，年龄（58.83±10.42）岁，定期复查主动脉 CTA（复查时间为 3～4 周），观察糖尿病患者和非糖尿病患者主动脉壁内血肿的进展情况。 结果 24 例患者在复查时，出现 A 型主动脉夹层 2 例，B 型主动脉夹层 3 例（均为腹部局限性夹层）；4 例患者合并糖尿病，复查时 2 例进展为主动脉夹层，2 例血肿及溃疡加重。 结论 主动脉壁内血肿整体呈吸收趋势，无并发症发生。手术事件的发生率与患者合并糖尿病有密切关系。