主动脉弓部手术脑部并发症的危险因素分析  

The relative risk factors of cerebral complication following aortic arch surgery

作　　者：刘楠[1] 孙立忠[1] 常谦[1] 刘平[1] 张海涛[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院心外科,北京100037

出　　处：《中华胸心血管外科杂志》2005年第5期272-274,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨主动脉弓部手术脑部并发症发生的相关危险因素。方法2003年8月至2004年7月,连续行主动脉弓部手术79例中男68例,女11例;平均(46±14)岁。对其脑部并发症的可能危险因素做统计学分析。结果除1例术后24h因心肺功能衰竭死亡外,该组病人脑部并发症的发生率28.2%(22/78例),其中暂时性脑损害(TND)15例(19.2%),永久性脑损害(PND)5例(6.4%),严重的全脑功能紊乱2例(2.6%)。脑部并发症的危险因素包括高血压病(P=0.012)、颈动脉受累(P=0.022)、体外循环(CPB)>180min(P=0.002)、主动脉阻断>120min(P=0.003)、术后血压波动超过80mmHg(10.7kPa)(P=0.000)、输血量>4000ml(P=0.004)。其中术后血压波动超过80mmHg及CPB>180min是脑部并发症发生的独立相关危险因素。结论主动脉弓部手术后的脑部并发症是多因素共同作用的结果。Objective To determine the risk factors of cerebral complication following aortic arch surgery with deep hypothermic circulatory arrest （DHCA） incombination with antegrode selective cerebral perfusion（ASCP）. Methods Between August 2003 and July 2004, 79 patients[68 male, 11 female, mean age （46 ± 14）years] underwent operations on the aortic arch with DHCA in combinatien with ASCP. Indications for surgical intervention were type A aortic dissection in 72 patients, degenerative anenrysm in 5 and false anenrysm in 2. For each patient, selective cerebral perfusion were used at a nasal ternperature of 18℃ o Mean cerebral perfusion time was （26 ± 14） minutes. Perioperative factors were evaluated by means of univariate and multivariate logistic analysis to identify relative risk factors of cerebral complication. Results Cerebral complications occurred in 22 patients（28.2% ）, including 15 patients（19.2%） with temporary cerebral dysfunction and 5（6.4%） patients with permanent cerebral dysfunction, 2 patients （2.6%） with severe global cerebral dysfunction. Hypertension disease （P = 0.012）, CPB time 〉 180 min（P = 0.002）, aortic eroasdamp time 〉 120 min （ P = 0.003 ）, arterial blood pressure instability （ P =- 0. 000） and blood transfiusion volumn 〉 4 000 ml （ P = 0.004） are the risk factors for cerebral complication. CBP time 〉 180 min and arterial blood pressure instability are independent determinats for cerebral complication. Conclusion No single risk factor explained the onset of cerebral complication. Rather, a combination of factors, especially longer CPB time, postoperative arterial blood pressure instability produced the highest odds of deficit.

关 键 词：主动脉 胸/外科学 手术后并发症 脑 危险因素 体外循环 血压 危险因素分析 脑部并发症 主动脉弓部 手术后 

分 类 号：R654.2[医药卫生—外科学]