不同复温比值对减少深低温停循环患者术后神经精神并发症的有效性  

Postoperative neuroprotective effect of different ratios of circulatory arrest time to rewarming time in patients undergoing deep hypothermic circulatory arrest

作　　者：陆秉玮[1] 孙晓琼[1] 陈杰[1] 王维俊[2] 薛松[2] 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 [2]上海交通大学医学院附属仁济医院心胸外科,200127

出　　处：《上海医学》2011年第12期907-910,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：目的探讨不同复温比值(停循环时间与复温时间的比值)对减少深低温停循环(DHCA)患者术后神经精神系统并发症的有效性。方法行DHCA的患者57例,根据术中的脑灌注情况,分为DHCA联合选择性脑灌注组(Ⅰ组,20例)及单纯DHCA组(Ⅱ组,37例),再根据复温比值进一步分组,复温比值≥0.1且≤0.5为ⅠA组(13例)和ⅡA组(29例),复温比值>0.5且≤0.7为ⅠB组(7例)和ⅡB组(6例),复温比值>0.9的2例患者另行讨论。监测各组的体外循环(CPB)时间、辅助循环时间、最低鼻咽温度(PT)及最低直肠温度(RT),测定麻醉后行CPB前(T0)、CPB开始后DHCA开始前(T1)、DHCA结束恢复CPB后5～10min(T2)以及停止CPB后(T3)的平均动脉压(MAP)、红细胞压积(Hct)、PT及RT。记录各组的术后神经、精神并发症的发生情况。结果ⅠA、ⅠB、ⅡA、ⅡB组在T0、T1、T2及T3时间点的MAP、Hct、PT及RT的差异均无统计学意义(P值均>0.05),CPB时间、辅助循环时间、最低PT、最低RT及机械通气时间的差异均无统计学意义(P值均>0.05);ⅠB组住重症监护病房的时间和住院时间均显著长于ⅠA组(P值均P<0.05)。57例患者术后的神经并发症发生率为10.5%(6/57),精神并发症发生率为19.3%(11/57)。Ⅰ组术后的神经及精神并发症发生率为10.0%(2/20),显著低于Ⅱ组的40.5%(15/37,P<0.05);ⅠA、ⅠB、ⅡA、ⅡB组术后的神经及精神并发症发生率分别为15.4%(2/13)、0、27.6%(8/29)、83.3%(5/6),ⅡB组的并发症发生率显著高于ⅠA及ⅡA组(P值均<0.05)。结论复温比值≥0.1且≤0.5对降低单纯行DHCA患者术后神经精神并发症有效。Objective To observe the postoperative neuroprotective effect of different ratios of circulatory arrest time to rewarming time in patients undergoing deep hypothermic circulatory arrest（DHCA）.Methods Fifty-seven patients with DHCA were divided into DHCA combined with selective cerebral perfusion group（group Ⅰ,n=20） and DHCA group（group Ⅱ,n= 37）.Each group was further divided into 2 subgroups：when the ratio of circulatory arrest time to rewarming time≥0.1 and ≤0.5,group ⅠA（n=13） and group ⅡA（n=29）;when the ratio0.5 and ≤0.7,group ⅠB（n= 7） and group ⅡB（n=6）.The other two cases with the ratio0.9 were discussed separately.Cardiopulmonary bypass（CPB） time,assisted circulation time,the lowest nasopharynx and rectal temperatures were measured.Mean arterial pressure（MAP）,hematocrit（Hct）,nasopharynx and rectal temperatures were recorded before CPB（T0）,before DHCA（T1）,5-10 min after restarting CPB（T2） and at the end of CPB（T3）.The postoperative nerve and mental complications were observed.Results The differences of MAP,Hct,nasopharynx and rectal temperatures between the patients in the 4 subgroups at T0,T1,T2 and T3 had no statistical difference（P0.05）,and neither had the differences of main parameters in DCHA,such as CPB time,assisted circulation time,the lowest nasopharynx and rectal temperatures（P0.05）.The incidence rates of nerve and mental complications in all the patients were 10.5%（6/57） and 19.3%（11/57）,respectively.The incidence rates of neuropsychiatric complications were 10.0%（2/20） in groupⅠ,40.5%（15/37） in group Ⅱ,15.4%（2/13） in group ⅠA,0 in group ⅠB,27.6%（8/29） in group ⅡA,and 83.3%（5/6） in group ⅡB.The difference between group ⅡA and group ⅡB had statistical significance（P0.05）.Conclusion Postoperative neuroprotection can be effectively achieved in the patients with DHCA when the ratio of circulatory arrest time to rewarming time is 0.1-0.5.

关 键 词：深低温停循环 复温比值 神经精神 并发症 

分 类 号：R654.1[医药卫生—外科学]