急性Stanford A型主动脉夹层术后发生神经功能障碍的危险因素分析  

Risk factors of post-operative neurological dysfunction in acute Stanford type A aortic dissection

作　　者：艾则热提艾力·麦麦提 刘圣辰[1] 李健[1] 周越赟 陈东良 景通 黄福华[1] Aizeretiaili Maimaiti;LIU Shengchen;LI Jian;ZHOU Yueyun;CHEN Dongliang;JING Tong;HUANG Fuhua(Department of Thoracic and Cardiovascular Surgery,Nanjing Hospital Affiliated to Nanjing Medical University,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)心胸血管外科,210006

出　　处：《心肺血管病杂志》2024年第6期610-617,共8页Journal of Cardiovascular and Pulmonary Diseases

基　　金：江苏省卫生健康委医学科研项目(ZD2022018)。

摘　　要：目的:探讨分析急性Stanford A型主动脉夹层术后发生神经功能障碍的危险因素。方法:回顾性收集2020年5月至2023年5月,本中心收治的行开放手术治疗的258例急性Stanford A型主动脉夹层患者的临床资料。根据术后是否发生神经功能障碍及其类型将患者分为对照组(n=194)和神经功能障碍(neurological dysfunction,ND)组(n=64)[其中暂时性神经功能障碍(transient neurological dysfunction,TND)38例,永久性神经功能障碍(permanent neurological dysfunction,PND)26例],分别进行单因素分析及多因素logistic回归分析。结果:258例急性Stanford A型主动脉夹层患者术后64例(24.8%)发生神经功能障碍,其中26例(10.1%)为PND,38例(14.7%)为TND。多因素Logistic回归分析提示,单侧脑灌注时间、术后低氧血症以及术后急性肾损伤是ND的危险因素。此外,Euro scoreⅡ评分对于预测术后ND具有较好的效能。与对照组相比,TND患者术后一年死亡率相近而PND组患者死亡率显著升高。结论:Euro scoreⅡ评分高,单侧脑灌注时间延长,术后低氧血症,术后急性肾损伤提示患者术后ND发生率较高;术中控制单侧脑灌注时间,术后积极干预低氧血症,可能会减少术后神经功能障碍的发生。Objective:To analyze the risk factors of postoperative neurological dysfunction in acute Stanford type A aortic dissection.Methods:The clinical data of 258 patients with acute Stanford type A aortic dissection,who underwent open surgical treatment in our center from May 2020 to May 2023,were collected.According to whether postoperative neurological dysfunction occurred and its type,the patients were divided into control group(n=194)and neurological dysfunction(ND)group(n=64)[including 38 cases of transient neurological dysfunction(TND)and 26 cases of permanent neurological dysfunction(PND)].Univariate analysis and multivariate Logistic regression analysis were performed respectively.Results:Among 258 patients with Acute Stanford type A aortic dissection,postoperative neurological dysfunction occurred in 64 cases(24.8%),of which 26 cases(10.1%)had PND and 38 cases(14.7%)had TND.Multivariate Logistic regression analysis showed that unilateral cerebral perfusion time, postoperative hypoxemia and postoperative acute kidney injury were independent risk factors for ND. Besides, Euros coreⅡ has better performance in predicting postoperative ND. Compared with the control group, the one-year mortality rate of TND patients was similar, while the mortality rate of patients in the PND group was significantly higher. Conclusions: A higher Euro score Ⅱ score, prolonged unilateral cerebral perfusion time, postoperative hypoxemia and postoperative acute kidney injury indicate a higher incidence of postoperative ND in patients. Controlling the unilateral cerebral perfusion time during surgery and actively intervening for hypoxemia after surgery may reduce the incidence of postoperative neurological dysfunction.

关 键 词：急性Stanford A型主动脉夹层 术后神经功能障碍 危险因素 

分 类 号：R54[医药卫生—心血管疾病]