深低温停循环联合顺行性脑灌注对患者认知功能的影响

目的探讨急性StanfordA型主动脉夹层采用深低温停循环联合顺行性脑灌注对患者认知功能的影响。方法2009年1月至2012年3月南京医科大学附属南京医院48例急性StanfordA型主动脉夹层采用孙氏手术（主动脉弓部置换加支架象鼻手术），其中男40例，女8例，年龄（51．3±13．6）岁。手术均采用深低温停循环、顺行胜脑灌注技术。记录术中停循环时间、术后苏醒时间，根据简易智力状态检查量表（mini．mentalstatesexamination，MMSE）评价患者术前、术后的认知功能。结果48例患者体外循环时间（237．3±58．5）rain，术中停循环时间（37．3±6．9）min。手术死亡4例，死亡原因：肺部感染、多脏器功能衰竭、心肌梗死和急性呼吸窘迫综合征。4l例患者术后24h内苏醒，苏醒时间（1513±6．5）h。MMSE评分术前为（28．6±1．1）分，术后1周时为（23．6±4．5）分。随访3l例，随访率70．45％，随访时间6个月。术后6个月时31例患者MMSE评分为（27．6±2．1）分，较术后MMSE评分大幅度提高（户〈0．05），但与术前MMSE比较，差异无统计学意义（P〉0．05）。结论治疗急性StanfordA型主动脉夹层采用深低温停循环联合顺行性脑灌注技术，可以取得满意的脑保护效果，但短期内对认知功能可能存在负面影响；只要头颅CT排除梗塞或出血病灶，这种负面影响在半年内基本可以自行消除。

Impact of Deep Hypothermic Circulatory Arrest with Antegrade Cerebral Perfusion on Cognitive Function

Objective To investigate the impact of deep hypothermic circulatory arrest （DHCA） with antegrade cerebral perfusion （ACP） on cognitive function of patients undergoing surgical therapy for acute Stanford type A aortic dissection （AD）. Methods Between January 2009 and March 2012,48 patients with acute Stanford type A AD underwent Sun＇s procedure （aortic arch replacement combined with stented elephant trunk implantation） under DHCA with ACP in Nanjing Hospital affiliated to Nanjing Medical University. There were 40 males and 8 females with their age of 51.3 ± 13.6 years. Circulatory arrest time and time for postoperative consciousness recovery were recorded. Preoperative and postoperative cognitive functions of each patient were evaluated by mini-mental status examination （MMSE）. Results Mean cardiopu- lmonary bypass time of the 48 patients was 237.3 ± 58.5 minutes, and mean circulatory arrest time was 37.3 ±6.9 minutes. Four patients died postoperatively with the causes of death including lung infection, multiple organ dysfunction syndrome, myocardial infarction and acute respiratory distress syndrome. Forty-one patients recovered their consciousness within 24 hours postoperatively, and the mean time for postoperative consciousness recovery was 15.3 ~ 6.5 hours. Preoperative MMSE score was 28.6 ± 1.1 points, and MMSE score at 1 week postoperatively was 23.6±4.5 points. Thirty-one patients were followed up for 6 months with the follow-up rate of 70.45%. The average MMSE score of the 31 patients at 6 months after surgery was 27.6 ± 2.1 points which was significantly higher than postoperative average MMSE score （P 〈 0.05 ）, but notstatistically different from preoperative average MMSE score （P 〉 0.05）. Conclusions DHCA with ACP can provide satisfactory cerebral protection for patients undergoing surgical therapy for acute Stanford type A AD, but patients＇ cognitive function may be adversely affected in the short term. As long as cerebral infarction or hemorrhage is excluded in CT scan of the brain, such adverse impact may generally disappear automatically within 6 months after surgery.