RÉSUMÉ
Objective:To evaluate the efficacy of middle cerebral artery (MCA) blood flow velocity combined with regional saturation of cerebral oxygen (rScO 2) monitoring in guiding anterograde cerebral perfusion in the patients undergoing total arch replacement (TAR). Methods:Ninety-eight patients of either sex, aged 18-72 yr, with body mass index of 24-30 kg/m 2, of American Society of Anesthesiologists Physical Status classification Ⅳ, undergoing elective TAR, were selected. The patients whose anterograde cerebral perfusion mode was determined by the surgeon were enrolled in control group (group C), and the patients who selected the anterograde perfusion mode according to the guiding criteria were included in guidance group (group G), with 49 cases in each group. Cerebral anterograde perfusion mode, postoperative retention time of tracheal intubation, duration of stay in intensive care unit, total hospital stay, tracheotomy, recovery and discharge, postoperative stroke and death of patients were recorded in two groups. Results:Compared with group C, the ratios of bilateral cerebral perfusion and postoperative tracheotomy, incidence of stroke and postoperative mortality were significantly decreased, the ratio of good perfusion and rate of recovery and discharge were increased ( P<0.05), and no significant change was found in the retention time of endotracheal intubation, duration of stay in intensive care unit, and length of hospital stay in group G ( P>0.05). Conclusions:MCA blood flow velocity-rScO monitoring provides a good efficacy in guiding anterograde cerebral perfusion during TAR.