不同停循环时间对深低温停循环患者术后的脑保护效应  

Postoperative neuroprotective effect of different circulatory arrest periods in patients undergoing deep hypothermic circulatory arrest

作　　者：孙晓琼[1] 陆秉玮[1] 陈杰[1] 王维俊[1] 薛松[1] 王祥瑞[1] 

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,200127

出　　处：《上海医学》2011年第12期903-906,共4页Shanghai Medical Journal

基　　金：上海交通大学医学院麻醉学重点学科(2008)

摘　　要：目的观察不同停循环时间(CA时间)对深低温停循环(DHCA)患者术后的脑保护效应。方法应用DHCA的患者56例,根据术中行脑灌注的情况分为脑灌注组(18例)和对照组(38例)。再根据CA时间将各组分层:CA时间<40min为短CA时间亚组(脑灌注组11例,对照组33例),CA时间≥40min为长CA时间亚组(脑灌注组7例,对照组5例)。记录术前的一般资料、术中各项生理参数及术后神经精神症状发生情况,观察术后脑保护效应。结果脑灌注组的神经精神系统并发症发生率为11.1%(2/18),显著低于对照组的39.5%(15/38,P<0.05)。长CA时间患者的神经精神系统并发症发生率为41.7%(5/12),略高于短CA时间患者的27.3%(12/44),但差异无统计学意义(P>0.05)。脑灌注组短CA时间亚组的神经精神症状发生率为9.1%(1/11),脑灌注组长CA时间亚组为14.3%(1/7),对照组短CA时间亚组为33.3%(11/33),对照组长CA时间亚组为80.0%(4/5)。脑灌注组两亚组间神经精神症状发生率的差异无统计学意义(P>0.05),对照组长CA时间亚组的神经精神症状发生率显著高于对照组短CA时间亚组和脑灌注组长CA时间亚组(P值均<0.05),脑灌注组短CA时间亚组与对照组短CA时间亚组间神经精神症状发生率的差异无统计学意义(P>0.05)。结论脑灌注对行DHCA患者的术后脑保护有效,同时CA时间<40min对单纯DHCA患者术后脑保护有效。Objective To observe the postoperative neuroprotective effect of different circulatory arrest（CA） periods in patients with deep hypothermic circulatory arrest（DHCA）.Methods A total of 56 patients undergoing DHCA were divided into cerebral perfusion group（group Ⅰ,n=18） and control group（group Ⅱ,n=38）.According to different CA time,each group was further divided into two subgroups：CA40 min,group Ⅰa（n=11） and group Ⅱa（n=33）;and CA≥40 min,group Ⅰb（n=7） and group Ⅱb（n=5）.Preoperative clinical data,perioperative physiological parameters and postoperative neuropsychiatric symptoms were recorded,and the postoperative neuroprotective effect was observed.Results The incidence rate of neuropsychiatric complications in group Ⅰ（11.1%,2/18） was significantly lower than that in group Ⅱ（39.5%,15/38,P0.05）.The incidence rate of neuropsychiatric complications in the patients of CA≥40 min（41.7%,5/12） was a little higher than that in CA40 min（27.3%,12/44）,with the difference having no statistic significance（P0.05）.The incidence rates of neuropsychiatric symptoms in group Ⅰa,group Ⅰb,group Ⅱa and group Ⅱb were 9.1%（1/11）,14.3%（1/7）,33.3%（11/33） and 80.0%（4/5）,respectively.The difference between group Ⅰa and group Ⅰb had no statistical significance（P0.05）,and neither had the difference between group Ⅰa and group Ⅱa（P0.05）.The incidence rate of neuropsychiatric symptoms in group Ⅱb was significantly higher than those in group Ⅱa and group Ⅰb（P0.05）.Conclusion Cerebral perfusion is an effective method of neuroprotection in the patients with DHCA.Meanwhile,circulatory arrest less than 40 min can effectively protect the brain in the patients undergoing DHCA without cerebral perfusion.

关 键 词：深低温停循环 脑灌注 停循环时间 脑保护 并发症 

分 类 号：R654.1[医药卫生—外科学]