Stanford A型主动脉夹层涉弓手术后脑部并发症危险因素分析  

Analysis of risk factors of postoperative cerebral neurological complications afteroperation for Stanford type A aortic arch surgery

作　　者：顾继伟[1] 宋艳艳[1] 姜博[1] 吴喜娥 王云[1] Gu Jiwei;SONG Yanyan;JIANG Bo;WU Xie;WANG Yun(Department of Cardiovascular Surgery,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院心脏大血管外科,宁夏银川750004

出　　处：《宁夏医学杂志》2023年第5期416-419,共4页Ningxia Medical Journal

基　　金：宁夏回族自治区科技厅重点研发计划项目(2021BEG03070)。

摘　　要：目的探讨Stanford A型主动脉夹层患者涉弓手术后发生脑部并发症的危险因素。方法回顾性分析Stanford A型主动脉夹层进行弓部手术116例患者的临床资料,根据术后是否发生脑部并发症分为并发症组和无并发症组。采用单因素分析和多因素logistic回归分析方法,分析术后发生脑部并发症的危险因素。结果116例患者中术后发生脑部并发症31例,发生率26.72%,其中永久性神经功能障碍(PND)7例,短暂性神经功能障碍(TND)24例;发生脑部并发症组住院期间死亡6例,无并发症组死亡5例,总住院死亡率为9.48%。单因素分析显示,弓部手术后脑部并发症的危险因素有年龄、脑卒中史、颈动脉斑块或狭窄、急诊手术、术前肾功能不全、低血压、主动脉阻断时间、深低温停循环时间、术后低氧血症、低心排综合征、输血浆>800 mL、输红细胞悬液>6 u。多因素logistic回归分析显示,深低温停循环时间>40 min、输血浆>800 mL、输红细胞悬液>6 u、脑卒中史及颈动脉斑块或狭窄是Stanford A型主动脉夹层患者弓部手术后发生脑部并发症的独立危险因素。结论深低温停循环时间>40 min、输血浆>800 mL、输红细胞悬液>6 u、脑卒中史及颈动脉斑块或狭窄是Stanford A型主动脉夹层患者弓部手术后发生脑部并发症的独立危险因素,需要围手术期积极干预,以降低术后脑部并发症的发生。Objective To explore the risk factors of postoperative cerebral neurological complications after operation for Stanford type A aortic arch surgery.Methods 116 patients underwent arch surgery for Stanford type A aortic coarctation were retrospectively analyzed.The patients were divided into a complication group and an uncomplicated group according to whether postoperative brain complications occurred.And the related factors of cerebral neurological complications were analyzed by single factor analysis and multi-factor logistic regression.Results 31 cases of postoperative neurological complications occurred in 116 patients(26.72%),including 7 cases of permanent neurological deficits(PND)and 24 cases of transient neurological deficits(TND).There were six deaths during hospitalization in the group with cerebral complications and five deaths in the group without complications,with an overall in-hospital mortality rate of 9.48%.Single factor analysis showed the associated factors were age,stroke history,carotid plaque or stenosis,emergency surgery,renal dysfunction,hypotension,aorta clamping time,deep hypothermic circulatory arrest time,postoperative hypoxemia,low cardiac output syndrome,transfusion of plasma and red blood cell suspension.And multi-factor logistic analysis showed the independent predictive factors were DHCA time>40 min,transfusion of plasma and red blood cell suspension,history of stroke and carotid plaque or stenosis.Conclusion Deep hypothermic withdrawal time>40 min,transfusion of plasma>800 mL,transfusion of red cell suspension>6u,history of stroke and carotid plaque or stenosis are independent risk factors for cerebral complications after arch surgery in patients with Stanford type A aortic coarctation.Aggressive perioperative intervention is required to reduce the incidence of postoperative cerebral neurological complications.

关 键 词：Stanford A型主动脉夹层 主动脉弓部手术 脑部并发症 危险因素 

分 类 号：R654.3[医药卫生—外科学]