不同顺行脑灌注方法对急性Stanford A型主动脉夹层术后神经系统并发症的影响  

Postoperative neurological complications of different anterograde cerebral perfusion methods during acute stanford type A aortic dissection

作　　者：肖长波[1] 喻红霞[2] 袁义强 张力[1] 张亚飞 武刚[1] 高夏[1] 崔聪[1] 张向辉 孙科雄 陈玉新 王平凡[1] XIAO Changbo;YU Hongxia;YUAN Yiqiang;ZHANG Li;ZHANG Yafei;WU Gang;GAO Xia;CUI Cong;ZHANG Xianghui;SUN Kexiong;CHEN Yuxin;WANG Pingfan(Henan Prorincial Chest Hospital,Zhengzhou 450001,China;The Second Afiliated Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]河南省胸科医院,河南郑州450001 [2]郑州大学第二附属医院,河南郑州450003

出　　处：《中国实用神经疾病杂志》2021年第22期1988-1997,共10页Chinese Journal of Practical Nervous Diseases

基　　金：河南省医学科技攻关计划项目(编号:2018020551)。

摘　　要：目的探讨急性Stanford A型主动脉夹层(AAAD)术中应用右腋动脉和中心动脉联合头臂动脉两种不同顺行脑灌注方法对神经系统并发症的影响。方法回顾性分析河南省胸科医院心血管外科八病区(大血管病区)同一手术组2016-01—2021-01收治的急性Stanford A型主动脉夹层同期行弓部手术,并应用右腋动脉和主动脉+头臂动脉插管两种不同顺行脑灌注方法的319例患者的临床资料,对产生永久性神经损害和暂时性神经损害的病例进行对比分析。结果术后住院期间永久性神经系统功能损害(PND)16例,急性脑梗死8例,脑出血6例,缺血缺氧性脑病2例,其中右腋动脉组急性脑梗死5例,脑出血4例,缺血缺氧性脑病1例;中心动脉+头臂动脉组急性脑梗死3例,脑出血2例,缺血缺氧性脑病1例。短暂性神经系统功能不全(TND)57例,术后出现烦躁、谵妄、短暂性意识模糊等,其中右腋动脉组31例,中心动脉+头臂动脉组26例,经对症治疗,出院时均恢复正常。结论急性Stanford A型主动脉夹层术中中心动脉联合头臂动脉双插管与右腋动脉插管两种不同顺行脑灌注方法术后神经系统并发症并无显著差异,但中心动脉联合头臂动脉双插管患者的体外循环时间和手术时间优于右腋动脉插管。Objective To investigate the occurrence probability and causes of postoperative nervous system complications of two different anterograde cerebral perfusion methods during stanford type A aortic dissection.Methods A retrospective analysis of acute stanford type A aortic dissection(AAAD)treated in the same surgical group from January 2016 to January 2021 in Cardiovascular Surgery Ward 8 of Henan Chest Hospital. The data of 319 patients with right axillary artery aorta cannulation and central artery combined with brachiocephalic artery cannulation were analyzed and compared.Results There were 16 cases of permanent neurological impairment(PND),8 cases of acute cerebral infarction,6 cases of intracerebral hemorrhage and 2 cases of hypoxic-ischemic encephalopathy. In the right axillary artery group,there were 5 cases of acute cerebral infarction,4 cases of cerebral hemorrhage and 1 case of hypoxic-ischemic encephalopathy. In the central artery combined with brachiocephalic artery group,there were 3 cases of acute cerebral infarction,2 cases of intracerebral hemorrhage and 1 case of hypoxic-ischemic encephalopathy. There were 57 cases of transient nervous system dysfunction(TND).There were irritability,delirium and transient blurred consciousness after operation,including 31 cases in the right axillary artery group and 26 cases in the central artery with brachiocephalic artery group. After symptomatic treatment,they all returned to normal at discharge.Conclusion For acute stanford type A aortic dissection,there was no significant difference in postoperative neurological complications between the intraoperative cerebral perfusion method of central artery combined combined with brachiocebrachial artery double intubation and right axillary artery intubation,and the time of cardiopulmonary bypass and operation was better than that of right axillary artery intubation.

关 键 词：脑灌注 神经系统并发症 主动脉夹层 Stanford A型 急诊手术 弓部手术 

分 类 号：R543.1[医药卫生—心血管疾病]