三种脑灌注方案对行深低温停循环Stanford A型主动脉夹层病人围手术期临床指标、神经系统功能障碍发生率及心率变异性水平的影响  

Influence of three kinds of cerebral perfusion schemes on perioperative clinical indicators,ND incidence and HRV levels of patients with Stanford A type aortic dissection by DHCA

作　　者：韩冬[1] 孙君隽[1] 张超[1] HAN Dong;SUN Junjun;ZHANG Chao(Department of Cardiovascular Surgery,Central Hospital of Nanyang,Nanyang,Henan 473009,China)

机构地区：[1]南阳市中心医院心脏大血管外科,河南南阳473009

出　　处：《安徽医药》2020年第11期2229-2233,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨上腔静脉逆行脑灌注、顺行单侧脑灌注及改良顺行双脑灌注方案对行深低温停循环(DHCA)Stanford A型主动脉夹层病人围手术期临床指标、神经系统功能障碍(ND)发生率及心率变异性(HRV)水平的影响。方法选取2011年5月至2018年3月南阳市中心医院收治行DHCA Stanford A型主动脉夹层病人共120例,其中A组(40例)采用上腔静脉逆行脑灌注治疗,B组(40例)采用顺行单侧脑灌注治疗,C组(40例)采用改良顺行双脑灌注方案治疗,比较三组围手术期临床指标水平,ND发生率、HRV指标水平及死亡率。结果A、B、C三组病人手术时间[(7.58±1.57)比(7.42±1.43)比(7.19±1.33)h]、体外循环时间[(192.39±35.47)比(188.42±32.49)比(184.80±30.21)min]、降温时间[(46.58±6.22)比(44.20±5.98)比(43.46±5.69)min]、复温时间[(93.80±22.17)比(92.39±21.36)比(92.06±12.28)min]及气管切开率(12.50%比10.00%比7.50%)比较,差异无统计学意义(P>0.05);A、B、C三组脑灌注时间[(42.71±7.95)比(33.20±5.18)比(30.94±4.75)min]、辅助呼吸时间[(37.80±4.65)比(30.59±3.97)比(27.06±3.90)h]、ICU停留时间[(6.36±1.10)比(4.92±0.92)比(4.20±0.68)h]及术后住院时间[(18.44±3.30)比(14.10±2.69)比(12.86±2.54)d]比较,C组均显著少于A组、B组(P<0.05);三组短暂性神经系统功能障碍(TND)发生率比较,C组(10.00%)均显著低于A(42.50%)、B组(20.00%)(P<0.05);三组永久性神经系统功能障碍(PND)发生率比较差异无统计学意义(P>0.05);B、C组全部窦性R-R间期标准差(SDNN)、24 h内每5 min时段窦性R-R间期均数的标准差(SDANN)、24 h内全部窦性R-R间期差值的均方根值(rMSSD)及24 h内两个相邻R-R间期互差>50 ms的心跳数所占分析信息间期内心搏数的百分比(PNN50)水平均显著高于A组(P<0.05);A组、B组及C组病人死亡率分别为2.50%(1/40),0.00%(0/40),0.00%(0/40),差异无统计学意义(P>0.05)。结论改良顺行双脑灌注方案用于行DHCA Stanford A型主动脉夹层病人Objective To investigate the influence of retrograde cerebral perfusion,selective unilateral antegrade cerebral perfusion and improved bilateral cerebral antegrade perfusion on perioperative clinical indicators,nervous dysfunction(ND)incidence and heart rate variability(HRV)levels of patients with Stanford A type aortic dissection by Deep hypothermic circulatory arrest(DHCA).Methods A total of 120 patients with Stanford A type aortic dissection by DHCA admitted to Central Hospital of Nanyang from May 2011 to March 2018 were chosen and divided into 3 groups including A group(40 patients)with retrograde cerebral perfusion,B group(40 patients)with selective unilateral antegrade cerebral perfusion and C group(40 patients)with improved bilateral cerebral antegrade perfusion.The levels of perioperative clinical indicators,ND incidence,levels of HRV ralated index and mortality of the 3 groups were compared.Results There was no significant difference in the operation time[(7.58±1.57)vs.(7.42±1.43)vs.(7.19±1.33)h],cardiopulmonary bypass time[(192.39±35.47)vs.(188.42±32.49)vs.(184.80±30.21)min],temperature fall time[(46.58±6.22)vs.(44.20±5.98)vs.(43.46±5.69)min],rewarming time[(93.80±22.17)vs.(92.39±21.36)vs.(92.06±12.28)min]and tracheotomy rate(12.50%vs.10.00%vs.7.50%)between A,B and C group(P>0.05).As for the cerebral perfusion time[(42.71±7.95)vs.(33.20±5.18)vs.(30.94±4.75)min],auxiliary breathing time[(37.80±4.65)vs.(30.59±3.97)vs.(27.06±3.90)h],ICU residence time[(6.36±1.10)vs.(4.92±0.92)vs.(4.20±0.68)h]and postoperative hospital staying time[(18.44±3.30)vs.(14.10±2.69)vs.(12.86±2.54)d]of A,B and C group,those in C group were significantly shorter than those in A and B group(P<0.05).The temporary nervous dysfunction(TND)incidence of C group(10.00%)were significantly lower than that in A group(42.50%)and B group(20.00%)(P<0.05).There was no significant difference in the permanent nervous dysfunction(PND)incidence among the 3 groups(P>0.05).The levels of SDNN,SDANN,rmSSD and PNN50 of B and C grou

关 键 词：主动脉瘤 胸/外科学 脑灌注 深低温停循环 Stanford A型主动脉夹层 疗效 

分 类 号：R654.3[医药卫生—外科学]