主动脉弓部手术降温温度与神经系统预后的相关性研究:单中心回顾性队列研究  

The correlation between intraoperative temperature and postoperative neurological prognosis in aortic arch surgery:a single-center retrospective cohort study

作　　者：朱凯 潘旭东[1] 董松波[1] 郑军[1] 刘永民[1] 郑斯宏[1] 孙立忠[1] Zhu Kai;Pan Xudong;Dong Songbo;Zheng Jun;Liu Yongmin;Zheng Sihong;Sun Lizhong(Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing Aortic Disease Center,Beijing Aortic Surgery Implantable Artificial Materials Engineering Technology Research Center,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心外科,北京市心肺血管疾病研究所,北京市大血管疾病诊疗研究中心,北京市大血管外科植入式人工材料工程技术研究中心,北京100029

出　　处：《中华胸心血管外科杂志》2022年第4期223-229,共7页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京市自然科学基金(7202038)。

摘　　要：目的探究成人主动脉弓部手术, 体外循环降温温度与术后神经系统预后的相关性。方法连续收集北京安贞医院2017年1月至2020年12月, 单一术者应用浅-中低温停循环行主动脉弓部手术的患者共118例。根据术中停循环时的膀胱温分为3组:T1组[39例, (25.58±0.64)℃];T2组[39例, (28.21±0.77)℃];T3组[40例, (30.95±0.9)℃]。比较组间临床资料, 探究术中降温温度与术后神经系统并发症的相关性。结果 118例患者平均手术、体外循环、阻断、停循环及选择性脑灌注时间分别为6.64 h、188.5 min、104.19 min、23.93 min、28.81 min。全组院内死亡8例(6.78%), 永久性神经系统功能障(PND)13例(11.02%), 短暂性神经系统功能障碍(TND)25例(21.19%)。3组术后死亡比例差异无统计学意义, T3组患者术后TND及PND发生率显著降低(P=0.042;P=0.045)。术后24 h引流量及二次开胸止血率均降低(P=0.005;P=0.012)。多元回归分析模型下, 术中降温温度与术后PND发生率独立相关(OR=0.51, 95%CI:0.27~0.97, P=0.0389);分组比较, 相对较高的温度是避免术后PND发生的独立保护因素(OR=0.04, 95%CI:0~0.91, P=0.0434)。结论主动脉弓部手术中, 浅低温可以降低深低温的并发症发生率, 同时可以改善神经系统预后, 降低术后PND发生率。Objective To explore the correlation between intraoperative cooling temperature and postoperative neurological prognosis in aortic arch surgery.Methods We observed and collected data from 118 patients who underwent open arch replacement surgery by a single surgeon with mild-to-moderate hypothermic circulatory arrest,from January 2017 to December 2020,in Beijing Anzhen Hospital.According to the bladder temperature during the circulation arrest,118 patients were divided into 3 groups:T1 group[n=39,(25.58±0.64)℃];T2 group[n=39,(28.21±0.77)℃];T3 group[n=40,(30.95±0.97)℃].Clinical data and operative data were analyzed to assess difference between these 3 groups.Analyze the risk factors of postoperative neurological complications,and explore further the correlation between intraoperative core temperature and postoperative neurological prognosis.Results Among the 118 patients,the average operation,cardiopulmonary bypass(CPB),block,circulatory arrest,and selective cerebral perfusion(SCP)time were 6.64 h,188.5 min,104.19 min,23.93 min,28.81 min,respectively.The in-hospital death occurred in 8 patients(6.78%),and permanent neurological dysfunction(PND)in 13 patients(11.02%),transient neurological dysfunction(TND)in 25 patients(21.19%).There was no significant difference in the deaths among the three groups.The incidence of TND and PND in the T3 group was significantly reduced(P=0.042;P=0.045).In addition,the volume of drainage during the first 24 h and the incidence of re-exploration for bleeding had a relatively obvious decreasing trend(P=0.005;P=0.012).Through multiple regression analysis,under the adjusted model,the core temperature was independently correlated with the incidence of postoperative PND(OR=0.51;95%CI:0.27-0.97;P=0.0389);in group comparison,the relatively higher core temperature was an independent protective factor for postoperative PND(OR=0.04;95%CI:0.00-0.91;P=0.0434).Conclusion Our research had preliminary proved that in the open arch replacement surgery,mild hypothermia can reduce the incidence

关 键 词：主动脉弓部手术 浅低温停循环 神经系统并发症 

分 类 号：R654.3[医药卫生—外科学]