中度低温停循环在老年A型夹层行全弓置换手术中的应用  

Application of Moderate Hypothermia Cirwlatory Arrest in Elderly Patients Undergoing Total Arch Replacement with Type A Dissection

作　　者：李博[1] 陈庆良[1] 姜楠[1] 赵丰[1] LI Bo;CHEN Qing-liang;JIANG Nan;ZHAO Feng(Department of Cardiology,Tianjin Chest Hospital,Tianjin,300222 China)

机构地区：[1]天津市胸科医院心脏外科,天津300222

出　　处：《世界复合医学》2020年第6期10-14,共5页World Journal of Complex Medicine

基　　金：天津市科委重大疾病防治科技重大专项,天津市老年夹层动脉瘤的临床诊疗研究(18ZXDBSY00160)。

摘　　要：目的回顾性分析中度低温停循环(MHCA)在该院老年A型夹层行全弓置换治疗的效果和安全性。方法自2017年8月—2019年2月,46例行全弓置换的老年(年龄≧60岁)主动脉夹层患者均采用MHCA方式。术后对院内病死率、连续性肾脏替代治疗(CRRT)发生率、神经系统并发症发生情况等,进行统计学分析。结果采用MHCA行全弓置换术,平均心肺转流(CPB)时间(170±41)min,平均停循环温度(27.6±2.8)℃,平均停循环时间(21±7)min,术后院内死亡2例(4.35%),行CRRT患者6例(13.04%),暂时性神经系统损伤患者7例(15.22%),新发脑梗塞/脑出血2例(4.35%)。肝功能指标均在1周内恢复正常。多因素Logistics回归分析发现停循环温度是终点事件的保护性因素(OR=0.630 P=0.018)。结论老年A型夹层患者行全弓置换过程中应用MHCA安全有效,不会增加术后院内病死率和并发症发生率,还可以避免深低温停循环造成的不利影响。Objective To retrospectively analyze the effect and safety of moderate hypothermia arrest(MHCA)in our hospital for the treatment of type A dissection with total arch replacement.Methods From August 2017 to February 2019,46 elderly patients(age≥60 years)with aortic dissection who underwent total arch replacement were treated with MHCA.After the operation,statistical analysis was conducted on the hospital mortality,the incidence of continuous renal replacement therapy(CRRT),and the occurrence of neuro-logical complications.Results MHCA was used for total arch replacement.The average cardiopulmonary bypass(CPB)time was(170±41)min,the average cessation temperature was(27.6±2.8)℃,the average cessation time was(21±7)min,and 2 patients died(4.35%)in the hospital.There were 6 patients with CRRT(13.04%),7 patients with temporary nervous system injury(15.22%),and 2 patients with new cerebral infarction/cerebral hemorrhage(4.35%).Liver function indexes returned to normal within 1 week.Multivariate Logistics regression analysis found that stop-cycle temperature was a protective factor for the end event(OR=0.630 P=0.018).Conclusion It is safe and effective to use MHCA in elderly patients with type A dissection during total arch replacement.It will not increase the postoperative mortality and complication rate in the hospital.It can also avoid the adverse effects caused by deep hypothermic circulatory arrest.

关 键 词：中度低温 A型夹层 全弓置换 老年患者 

分 类 号：R654[医药卫生—外科学]