急性A型主动脉夹层患者主动脉弓手术后PND的危险因素  

Risk factors for permanent nerve damage after aortic arch surgery in patients with acute type A aortic dissection

作　　者：吴江丽 徐小佳 谢萱 马丽萍[1] 马淑贤[1] 冯晓贤 任建军[1] Wu Jiangli;Xu Xiaojia;Xie Xuan;Ma Liping;Ma Shuxian;Feng Xiaoxian;Ren Jianjun(Department of Anesthesiology,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Anesthesiology,Zhengzhou People′s Hospital,Zhengzhou 453003,China)

机构地区：[1]河北医科大学第二医院麻醉科,石家庄050000 [2]郑州人民医院麻醉科,郑州453003

出　　处：《中华麻醉学杂志》2024年第11期1311-1316,共6页Chinese Journal of Anesthesiology

摘　　要：目的确定急性A型主动脉夹层(AAAD)患者主动脉弓手术后永久性神经损害(PND)的危险因素。方法本研究为回顾性病例对照研究。收集2018年12月至2023年12月在河北医科大学第二医院行主动脉弓手术的AAAD患者的病历资料,性别不限,年龄>18岁,ASA分级Ⅳ级。根据术后是否发生PND分为非PND组和PND组。收集患者术前资料,包括年龄、性别、BMI;合并疾病(高血压、冠心病、糖尿病)、既往吸烟史、脑卒中病史、心血管手术史;发病时晕厥、术前低SpO_(2)、低SBP和低DBP情况。术中资料包括手术方式(主动脉全弓置换术或主动脉半弓置换术)、术中选择性顺行性脑灌注方式、CPB时间、主动脉阻断时间、CPB后并行时间、中低温停循环时间、停循环期间鼻咽温度和直肠温度、停循环期间BIS值;CPB期间和心脏复跳后BP;心脏复跳后功能障碍和停CPB后止血困难发生情况。将上述指标进行差异性检验,将P<0.05的指标纳入多因素logistic回归分析,筛选PND的危险因素。结果最终纳入292例患者,其中有73例发生术后PND,发生率为25.0%。多因素logistic回归结果显示,年龄≥62岁(OR=3.783,95%CI 1.513~10.346,P=0.006)、术前合并高血压(OR=2.230,95%CI 1.118~4.715,P=0.028)、发病时晕厥(OR=3.001,95%CI 1.343~6.710,P=0.007)、停循环期间BIS值>14(OR=2.439,95%CI 1.249~4.755,P=0.009)和停CPB后止血困难(OR=3.465,95%CI 1.758~6.882,P<0.001)是术后PND的危险因素。结论年龄≥62岁、术前合并高血压、发病时晕厥、停循环期间BIS值>14和停CPB后止血困难是AAAD患者主动脉弓手术后PND的危险因素。Objective To determine the risk factors for permanent nerve damage(PND)after aortic arch surgery in patients with acute type A aortic dissection(AAAD).Methods This was a retrospective case-control study.The medical records from patients of both sexes with AAAD,aged>18 yr,of American Society of Anesthesiologists Physical Status classification IV,who underwent aortic arch surgery in the Second Hospital of Hebei Medical University from December 2018 to December 2023,were collected.The patients were divided into non-PND group and PND group according to whether PND occurred after operation.The preoperative data of patients were collected,including age,gender,body mass index;comorbidities(hypertension,coronary heart disease,diabetes mellitus),history of smoking,history of stroke,and history of cardiovascular surgeries;syncope at onset,preoperative low SpO_(2),preoperative low systolic blood pressure,and preoperative low diastolic blood pressure.The intraoperative data included surgical procedure(total aortic arch replacement or half aortic arch replacement),selective antegrade cerebral perfusion during operation,cardiopulmonary bypass(CPB)time,aortic cross-clamp time,post-parallel time,moderate hypothermia circulatory arrest time,nasopharyngeal temperature and rectal temperature during circulatory arrest,and BIS value during circulatory arrest;blood pressure during cardiopulmonary bypass and after restoration of heart beat;the incidence of dysfunction after recovery of heart beat and difficulty in hemostasis after termination of CPB.The aforementioned indicators were analyzed for difference,and the indicators with P<0.05 were included in the multivariate logistic regression analysis.Results A total of 292 patients were ultimately included,among which 73 developed postoperative PND,resulting in an incidence of 25.0%.The results of multivariate logistic regression analysis showed that age≥62 yr(OR=3.783,95% confidence interval[CI]1.513-10.346,P=0.006),preoperative hypertension(OR=2.230,95%CI 1.118-4.715,P=0.028),syncop

关 键 词：动脉瘤 夹层 危险因素 手术后并发症 永久性神经损害 

分 类 号：R654.3[医药卫生—外科学]