A型主动脉夹层术后脑部并发症危险因素分析  

Analysis of risk factors of postoperative neurological complications of type A aortic dissection

作　　者：罗海燕[1] 胡克俭[1] 刘祖赟[1] 程玥[1] 赵赟[1] 潘荪[1] 赵强[1] 王春生[1] 

机构地区：[1]复旦大学附属中山医院心外科,上海200032

出　　处：《中华胸心血管外科杂志》2009年第3期148-150,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：本课题受上海市重点学科建设项目资助（B116）

摘　　要：目的对160例在深低温停循环（DHCA）结合脑灌下行A型主动脉夹层手术术后脑部并发症危险因素进行相关分析。方法160例病人中男106例，女54例；年龄17～76岁，平均（56±13）岁。131例采用腋动脉插管选择性脑灌注（SCP），29例采用上腔静脉逆行性脑灌注（RCP）。对所有术前、术中相关因素行单因素及多因素分析。结果平均体外循环（CPB）（188±57）min，脑灌注（36±16）min。住院死亡16例。8例发生永久性神经功能障碍（PND），多因素分析示，与PND相关的危险因素有术前肾功能不全（OR=11．71，P=0．005）、伴有冠心病（CAD）（OR=7．35，P=0．035）、伴有脑血管病（CVD）OR=13．39，P=0．021）、术后低心排出量综合征（OR=22．21，P=0．008）；32例发生暂时性神经功能障碍（TND），年龄〉70岁（OR=1．17，P=0．042）是TND的相关危险因素。结论安全时限内的脑灌注时间、脑灌注方式不影响神经系统并发症。Objective Retrospectively analyze the risk factors of neurological complications of 160 patients with type A aortic dissection who underwent surgical repair using cerebral perfusion under deep hypothermia circulatory arrest and to sum the experience of cerebral protection. Methods From January 2004 to January 2008,160 patients with type A dissection underwent surgical repair with cerebral peffnsion and DHCA. There were 106 male patients and 54 female with age from 17 to 76 years old [mean, （56± 13） years old]. Antegrade selective cerebral perfusiou （SCP） through axillary artery was perfotmed for 131 patients and retrograde cerebral perfusian （RCP） from superior caval vein for 29 patients. Emergency surgery was performed in 83（51.8% ） patients who were sufeted from acute type A dissection, and the others were chronic elective surgery. All the factors underwent univariate and mulivariate analysis. Results Mean cardiopulmonary bypass （CPB） duration was （ 188 ± 57） minutes and mean cerebral perfusion time was （36± 16） minutes. Sixteen patients died in hospital and the in-hospital mortality was 10.0%. Deaths were due to multiple organ failure in 9 patients, respiratory failure in 2, low cardiac output syndrome in 2, bloeding in 2, septic shock in 1. Postoperative respiratory dysfunction were observed in 22 （13.7 % ） patients. Postoperative renal failure happened in 20（ 12.5 % ） patients. Postoperative low cardiac output appeared in 8（5.0% ） patients. Permanent neurological deficits occurred in 8（5.0% ） patients. The preoperative renal dysfunction （OR = 11.71, P = 0.005）, coronary artery disease （ OR = 7.35, P = 0.035 ）, cerebral vascular disease （ OR = 13.39, P = 0.021 ） and postoperative low cardiac output （ OR = 22.21, P = 0.008 ） were found to be the relative risk factors. Transient neurological deficits（ TND ） were noted in 32 patients. Over seventy years old （ OR = 1.17, P = 0. 042 ） was the independent risk predictors. Surgery procedures, CPB

关 键 词：动脉瘤 夹层 体外循环 手术后并发症 危险因素 神经系统疾病 

分 类 号：R686[医药卫生—骨科学]