改良顺行双脑灌注对Stanford A型主动脉夹层深低温停循环患者心率与神经功能的影响  

Effects of modified anterograde bi-cerebral perfusion on heart rate and neurological function in patients with Stanford type A aortic dissection deep hypothermia

作　　者：余成[1] 董明[1] 朱艺[1] 吴朝光[1] 岳颉 Yu Cheng;Dong Ming;Zhu Yi;Wu Chaoguang;Yue Jie(Department of Cardiac Surgery,Hainan Provincial People's Hospital,Haikou 570311,Hainan,China;Department of Vascular Surgery,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,Guangdong,China)

机构地区：[1]海南省人民医院心脏外科,海南海口570311 [2]广州医科大学附属第一医院血管外科,广东广州510120

出　　处：《血管与腔内血管外科杂志》2021年第8期966-970,981,共6页Journal of Vascular and Endovascular Surgery

摘　　要：目的探讨改良顺行双脑灌注对Stanford A型主动脉夹层深低温停循环患者心率与神经功能的影响。方法收集海南省人民医院2017年4月至2020年4月收治103例Stanford A型主动脉夹层患者临床资料,根据脑灌注方式不同分为单侧组(采用顺行单侧脑灌注治疗,n=46)和改良组(采用改良顺行双脑灌注,n=57)。比较两组患者手术相关指标、心率变异性(HRV)指标[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)、24 h内两个相邻R-R间期互差>50 ms的心率所占分析信息间期内心搏数百分比(PNN50)],比较术后即刻与术后24 h血清血管损伤标志物[人血管生成素-2(ANG-2)、血管内皮生长因子(VEGF)、晚期糖基化终末产物受体(AGE)、细胞间黏附分子-1(ICAM-1)水平],比较两组患者术后神经功能并发症发生率。结果改良组患者脑灌注时间、呼吸支持时间、重症医学科时间、住院总时间均少于单侧组患者;SDNN、SDANN、rMSSD和PNN50均高于单侧组患者;改良组患者的AGE水平低于术后即刻,术后24 h改良组患者的ANG-2、VEGF、ICAM-1、AGE均低于单侧组患者,差异有统计学意义(P<0.05)。两组患者均未发生永久性神经系统功能障碍,改良组患者短暂性神经系统功能障碍发生率为5.26%,低于单侧组的19.57%,差异有统计学意义(P<0.05)。结论改良顺行双脑灌注可减轻Stanford A型主动脉夹层深低温停循环患者的术后HRV与血管再灌注损伤程度,降低术后神经系统功能障碍发生风险。Objective To investigate the effect of modified anterograde bilateral cerebral perfusion on heart rate and neurological function in patients with Stanford type A aortic dissection deep hypothermic circulatory arrest.Method The clinical data of 103 patients with Stanford type A aortic dissection treated in Hainan Provincial People's Hospital from April 2017 to April 2020 were collected.They were divided into unilateral group(anterograde unilateral cerebral perfusion,n=46)and modified group(anterograde bilateral cerebral perfusion,n=57).The operation related indexes and heart rate variability indexes of the two groups were compared[the standard deviation of R-R interval(SDNN)of all sinus,standard diviation of normal R-R average intervals(SDANN)for all 5-minute segments in a 24-hour,the root mean square value(rMSSD)of all sinus R-R interval differences within 24 h,the percentage of heart rate with two adjacent R-R interval differences>50 ms in the analysis information interval cardiac beats(PNN50)],the levels of serum vascular injury markers[human angiopoietin-2(Ang-2),vascular endothelial growth factor(VEGF),receptor for advanced glycation end product(AGE)and intercellular adhesion molecule-1(ICAM-1)immediately after operation and 24 hours after operation]were compared,and the incidence of postoperative neurological complications was compared between the two groups.Result The cerebral perfusion time,respiratory support time,intensive care unit(ICU)time and total hospital stay in the improved group were less than those in the unilateral group;SDNN,SDANN,RMSSD and PNN50 were higher than those in unilateral group;the levels of AGE in the modified group were lower than those immediately after operation,and Ang-2,VEGF,ICAM-1 and AGE in the modified group were lower than those in the unilateral group 24 hours after operation(P<0.05).Permanent neurological dysfunction did not occur in both groups.The incidence of transient nervous system dysfunction in the improved group was 5.26%,lower than 19.57%in the unilateral group(

关 键 词：主动脉夹层 Stanford A型 改良顺行双脑灌注 深低温停循环 心率变异性 神经系统功能障碍 血管损伤 

分 类 号：R543[医药卫生—心血管疾病]