主动脉弓部手术后苏醒延迟的危险因素分析  

Risk Factor Analysis of Delayed Recovery of Consciousness after Aortic Arch Surgery

作　　者：崔辉敏[1,2] 李庆国[2] 王强[2] 王东进[1,2] 

机构地区：[1]南京医科大学鼓楼临床医学院,南京210029 [2]南京大学医学院附属鼓楼医院心胸外科,南京210008

出　　处：《中国胸心血管外科临床杂志》2013年第2期163-167,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：南京市医学科技发展项目(YKK09112)~~

摘　　要：目的探讨在深低温停循环(deep hypothermic circulatory arrest,DHCA)顺行选择性脑灌注(antegradeselective cerebral perfusion,ASCP)下行主动脉弓部手术后发生苏醒延迟的危险因素。方法回顾性分析2004年10月至2012年4月南京大学医学院附属鼓楼医院113例行主动脉弓部手术患者的临床资料,根据术后24 h患者神志是否恢复清醒,将113例患者分为神志恢复正常组[正常组,n=73,男55例,女18例;(48.1±10.9)岁]和苏醒延迟组[n=40,男29例,女11例;(52.2±11.4)岁]。采用单因素和logistic多因素回归分析导致患者术后发生苏醒延迟的危险因素。结果住院死亡9例(8.0%),其中死于多器官功能衰竭5例,心力衰竭2例,纵隔感染1例,肺出血1例。术后24 h内苏醒延迟组死亡7例(17.5%),正常组死亡2例(2.7%),苏醒延迟组病死率明显高于正常组(P=0.016)。随访94例(正常组65例、苏醒延迟组29例),随访时间4～95个月。随访期间死亡8例(正常组5例、苏醒延迟组3例),其中死于脑卒中2例,心力衰竭3例,肺出血2例,死亡原因不明1例。失访10例。主动脉弓部手术后苏醒延迟危险因素的单因素分析结果显示:年龄(P=0.042)、合并高血压病(P=0.017)、急诊手术(P=0.001)、体外循环时间(P=0.007)、升主动脉阻断时间(P=0.021)、输血(P=0.012)是主动脉弓部手术后发生苏醒延迟的危险因素。Logistic多因素回归分析结果显示:急诊手术(P=0.005)、体外循环时间>240 min(P=0.000)是导致主动脉弓部手术后发生苏醒延迟的独立危险因素。结论主动脉弓部手术后发生苏醒延迟是多因素共同作用的结果。术前应明确患者的诊断、发病部位、病变累及的范围,选择适宜的手术方式;术中加强脑保护的同时尽量缩短手术时间、改进手术操作、围术期维持循环平稳等均是预防苏醒延迟的重要措施。Objective To determine risk factors of delayed recovery of after aortic arch surgery under deep hypothermic circulatory arrest （DHCA） and antegrade selective cerebral perfusion （ASCP）. Methods We retro- spectively analyzed clinical data of 113 patients who underwent aortic arch surgery under DHCA±ASCP in the Affiliated Drum Tower Hospital, Medical School of Nanjing University from October 2004 to April 2012. According to whether they regained consciousness within 24 hours after surgery, all the 113 patients were divided into normal group （73 patients including 55 males and 18 females with their average age of 48.1 ± 10.9 years） and delayed recovery group （40 patients including 29 males and 11 females with their average age of 52.2±11.4 years）. Risk factors of delayed recovery of con- sciousness after surgery were evaluated by univariate analysis and multivariate logistic regression analysis. Results Nine patients （8.0%） died postoperatively, including 5 patients with multi-organ failure, 2 patients with heart failure, 1 patient with mediastinal infection, and I patient with pulmonary hemorrhage. There were 7 deaths （ 17.5% ） in the delayed recovery group and 2 deaths （2.7%） in the normal group, and the in-hospital mortality of the delayed recovery group was significant-ly higher than that of the normal group （P=0.016 ）. A total of 94 patients （including 65 patients in the normal group and 29 patients in the delayed recovery group） were followed up for 4-95 months. Eight patients （including 5 patients in the normal group and 3 patients in the delayed recovery group） died during follow-up, including 2 patients with stroke, 3 patients with heart failure, 2 patients with pulmonary hemorrhage and 1 patient with unknown cause. Ten patients were lost during follow-up. Univariate analysis showed that age （ P=0.042 ）, hypertension （ P=-0.017 ）, emergency surgery （ P=0.001 ）, cardiopu- lmonary bypass （CPB） time （P=0.007）, aortic cross-clamp time （P=0.021 ）,

关 键 词：深低温停循环 选择性脑灌注 主动脉弓部手术 苏醒延迟 危险因素 

分 类 号：R654.3[医药卫生—外科学]