主动脉弓置换术后永久性神经功能障碍的危险因素分析  

Analysis of the risk factors of permanent neurological dysfunction after aortic arch replacement

作　　者：武刚[1] 王平凡[1] 闫小清[1] 张力[1] 高夏[1] 张向辉 肖长波[1] 陈玉新 崔聪[1] 张亚飞 孙科雄 WU Gang;WANG Ping-fan;YAN Xiao-qing;ZHANG Li;GAO Xia;ZHANG Xiang-hui;XIAO Chang-bo;CHEN Yu-xin;CUI Cong;ZHANG Ya-fei;SUN Ke-xiong(Department of cardiac and vascular surgery,Henan Provincial Chest Hospital,Zhengzhou 450053,China)

机构地区：[1]河南省胸科医院心脏大血管外科,河南省郑州市450053

出　　处：《中国心血管病研究》2022年第1期57-61,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨主动脉弓置换术后永久性神经功能障碍(PND)的危险因素。方法回顾性分析我院2018年1月至2019年7月收治的150例A型主动脉夹层(AAD)患者,均在深低温停循环(DHCA)+单侧顺行性脑灌注(UACP)下行主动脉弓部手术。根据术后是否出现PND将患者分为两组,PND组(16例)和无神经功能障碍(NND)组(134例)。对两组间的基线数据、围术期治疗、术后结果进行对比,并将显著差异指标进行多变量logistic回归分析。结果 PND组缺血性脑卒中病史发生率明显高于NND组(P=0.027),PND组的术前住院日明显少于NND组(P=0.002)。两组在阻断时间和DHCA+UACP时间无显著性差异,但止血关胸时间差异有统计学意义(P=0.029)。PND组的悬浮红细胞输入量(P=0.021)和血浆输入量(P=0.011)明显增多,肾衰竭(P=0.019)、截瘫(P=0.009)、二次气管插管(P=0.002)、气管切开(P=0.006)发生率明显增多,呼吸机使用时间(P=0.017)和ICU停留时间(P=0.013)明显延长。多变量logistic回归显示缺血性卒中病史(OR=7.500,95%CI 1.511~37.216,P=0.014)、DHCA+UACP时间(OR=1.207,95%CI 1.013~1.438,P=0.036)、ICU停留时间(OR=1.073,95%CI 1.010~1.139,P=0.023)、止血关胸时间(OR=1.012,95%CI 1.002~1.021,P=0.017)是主动脉弓部置换术后出现PND的独立危险因素。结论弓部置换术后出现PND预后不良。缺血性脑卒中病史、DHCA+UACP时间、ICU停留时间和止血关胸时间是PND的独立危险因素。Objective To explore the risk factors of permanent neurological dysfunction(PND) after aortic arch replacement.Methods 150 patients with type A aortic dissection(AAD) from January 2018 to July 2019 in our hospital were retrospectively analyzed,who underwent aortic arch surgery under deep hypothermic circulatory arrest(DHCA)+unilateral antegrade cerebral perfusion(UACP).Patient were divided into two groups according to the presence or absence of PND after surgery,the PND group(n=16) and the nonneurological dysfunction(NND)group(n=134).The baseline data,perioperative treatment and postoperative results were compared between the two groups,and multivariate logistic regression analysis were used to analyze the significant differences.Results The incidence of the history of ischemic stroke in PND group was significantly higher than that in NND group(P=0.027).The preoperative hospital stays in PND group was significantly less than that in NND group(P=0.002).There was no significant difference between the two groups in the duration of aorta cross-clamping and DHCA+UACP,but the duration of hemostasis was statistically significant different(P=0.029).In PND group,volume of red blood cells(P=0.021) and plasma(P=0.011) transfusion were significantly increased;the incidences of renal injury(P=0.019),paraplegia(P=0.009),secondary endotracheal intubation(P=0.002) and tracheotomy(P=0.006)were significantly increased;the using time of breathing machine(P=0.017) and ICU stays(P=0.013) were significantly longer.Multivariate logistic regression showed the history of ischemic stroke(OR=7.500,95%CI 1.511~37.216,P=0.014),duration of DHCA + UACP(OR=1.207,95%CI 1.013~1.438,P=0.036)、ICU stays(OR=1.073,95%CI 1.010~1.139,P=0.023) and duration of hemostasis(OR=1.012,95%CI 1.002~1.021,P=0.017) were the independent risk factors of PND after aortic arch replacement.Conclusion The prognosis of PND after arch replacement is poor.History of ischemic stroke、duration of DHCA+UACP,ICU stays and duration of hemostasis are the independent risk fact

关 键 词：主动脉夹层 弓部置换 深低温停循环 选择性脑灌注 神经功能障碍 危险因素 

分 类 号：R543.1[医药卫生—心血管疾病]