摘要目的　为评估经右锁骨下动脉插管进行选择性顺行脑灌注（ASCP）的有效性和安全性，作为扩展主动脉外科全身停循环的安全期限的一种手段，用多单位神经监测来客观地量化其生理反应。方法　择期主动脉外科病人22例，所有病人年龄均小于60岁。术前用经颅多谱勒（TCD）确证颈动脉和锥基底动脉系统通畅和存在有效的侧枝灌注。通过右锁骨下动脉插管建立体外循环。用TCD测量大脑中动脉的峰血流速度，反映ASCP的幅度。同时，用双波长近红外线光谱仪持续监测局部脑氧饱和度（rSO2）。结果　所有病人恢复顺利。当ASCP流量< 5ml*kg-1*min-1时，则监测不到大脑中动脉血流，调节最低流量在15-20ml*kg-1*min-1时，则维持rSO2>50％。ASCP流量与大脑中动脉的峰血流速度和rSO2均呈高度相关性(r=0.86和0.96，P<0.01)。结论　神经监测下进行ASCP可能扩展主动脉外科全身停循环的安全期限，至少部分与本组缺少神经并发症有关。

abstractsObjective　To evaluate the safety and efficacy of antegrade selective cerebral perfusion (ASCP) during aortic arch surgery as a means of extending the safe period of systemic circulatory arrest using multimodality neuromonitoring to objectively quantify the physiologic responses. Methods　In twenty-two patients (all less than age 60) scheduled for repair of an aortic arch aneurysm, preoperative verification of effective collateral perfusion through both the carotid and vertebrobasilar arterial systems was documented with transcranial Doppler ultrasonography (TCD). During cardiopulmonary bypass, the sole arterial inflow from the pump was via the right subclavian artery. The magnitude of ASCP was quantified by TCD using peak middle cerebral artery velocity, while flow adequacy was measured by continuous regional cerebrovenous oxygen saturation (rSO2) using dual-wavelength spatially resolved near-infrared spectroscopy.Results　All patients experienced an uneventful recovery. Flow in the middle cerebral artery became undetectable at ASCP < 5*!ml*kg-1*min-1, so adjustments from a 15-20*!ml*kg-1*min-1 baseline were used to maintain rSO2 above 50%. Furthermore, ASCP flow was highly correlated (P<0.01) with both peak middle cerebral artery velocity and rSO2 (r=0.86 and 0.96, respectively). Conclusion　Neuromonitoring guided ASCP may be expected to extend the safe period and is at least partly responsible for the absence of neurologic complications in this patient cohort.