深低温停循环术后神经并发症危险因素及防治  

Risk factors and treatments for neurological complications after deep hypothermic ciculatory arrest operation

作　　者：费忠化[1] 李传文[2] 仇杰[1] 刘宏生[1] 马冬纹[1] 褚衍林[1] 

机构地区：[1]山东省济宁,山东省心脏疾病诊疗重点实验室-济宁医学院附属医院心脏ICU272029 [2]山东省济宁,山东省心脏疾病诊疗重点实验室-济宁医学院附属医院体外循环科272029

出　　处：《中国医师杂志》2014年第7期871-874,共4页Journal of Chinese Physician

摘　　要：目的探讨深低温停循环（DHCA）下主动脉手术后发生中枢神经系统（CNS）并发症的危险因素。方法2009年1月至2013年10月对70例主动脉夹层及主动脉瘤患者在DHCA下行手术治疗，根据术后有无CNS并发症分为并发症组（26例）和对照组（44例）。采用单因素和多因素Logistic回归分析危险因素。结果术后CNS并发症26例（37．14％），其中短暂性神经功能障碍18例，永久性神经功能障碍7例，截瘫1例；死亡1例。术前合并高血压（P=0．001）、发病72h内急症手术（P=0．009）、体外循环时间（P=0．015）、术中脑灌注流量（P=0．005）、术中血液稀释度（P=0．001）、术中及术后24h内红细胞（P=0．033）及血浆输注总量（P=0．034）、术后4h内氧合指数＜200mmHg（P=0．043）、术后24h血压波动〉80mmHg（P=0．037）、术后24h内血钠峰值（P=0．001）、急性生理与慢性健康评分-Ⅱ（APACHEⅡ）评分（P=0．008）为术后CNS损伤的危险因素。术前高血压病史（P=0．017）、发病后72h内急症手术（P=0．048）、术中脑灌注流量（P=0．015）、术后24h血钠＞150mmol／L（P=0．008）是术后CNS损伤的独立危险因素。结论术前充分评估病情，加强血压控制，术中选择合适的脑灌注方法和流量，合理控制血液稀释度，术后加强电解质监测及高钠血症及时防治，可望减少DHCA主动脉手术后CNS并发症的发生。Objective To investigate the risk factors for neurological complications after deep hypothermic ciculatory arrest （DHCA） operation. Methods From January 2009 to October 2013, 70 patients who were diagnosed as aortic dissection or aortic aneurysm underwent aortic operations under DHCA. According to the occurrence of neurological complications after surgery, patients were divided into neurological complication group （26 patients） and normal group （44 patients）. Risk factors of neurological complications after surgery were evaluated by univariate analysis and multivariate logistic regression analysis. Results Central neurological complications occurred in 26 patients （37. 14% ）, including 18 patients with temporary neurological dysfunction and 7 patients with perma- nent neurological dysfunction, 1 patient with paraplegia, 1 patient died of cerebral infarction. Univariate analysis showed that hypertension disease （ P = 0. 001 ）, emergency surgery within 72 hours （ P = 0. 009）, cardiopulmonary bypass time （ P = 0.015 ）, antegrade se- lective cerebral perfusion （ASCP） （ P = 0. 005）, hemodilution degree （ P = 0. 001 ）, erythrocyte （ P = 0. 033） and plasma （ P = 0. 034） transfusion volume in the perioperative period, oxygen index 〈200mmHg in 4 hours postoperatively （ P = 0. 043 ）, arterial blood pressure instability （ P = 0. 037 ） and hypernatremia in 24 hours postoperatively（ P = 0. 001 ）, and the Acute Physiology And Chronic Health Evaluation II （APACHE Ⅱ） score are the risk factors for central neurological complication. Hypertension disease（ P = 0. 017）, emergency surgery within 72 hours （ P = 0. 048 ）, ASCP （ P = 0. 015 ）, hypernatremia in 24 hours postoperatively （ P = 0. 008） were independent determinats for central neurological complication. Conclusions A series of procedure including evaluating patients condition correctly before operation, controlling hypertension effectively in the perioperative period, applying the ASCP and th

关 键 词：动脉瘤 夹层 外科学 主动脉疾病 外科学 主动脉瘤 外科学 手术后并发症 停循环 深低温诱导 中枢神经系统 危险因素 

分 类 号：R654.1[医药卫生—外科学]