急性Stanford A型主动脉夹层术后急性肾功能损伤的危险因素分析

目的分析急性Stanford A型主动脉夹层术后急性肾功能损伤(AKI)的危险因素。方法回顾性分析青岛市市立医院2010年9月至2017年9月间220例Stanford A型主动脉夹层手术患者的资料。平均年龄(52.3±8.7)岁,男162例(73.6%)、女58例(26.4%)。按患者术后是否发生AKI分2组:发生AKI者40例(A组),其中男29例、女11例,平均年龄(54.6±9.2)岁;未发生AKI者180例(B组),男133例、女47例,平均年龄(48.5±7.9)岁。对两组患者围术期多项指标进行单因素和多因素分析。结果住院死亡12例(5.5%),发生AKI组患者死亡7例(17.5%),未发生AKI组患者死亡5例(2.8%)。单因素分析显示,两组患者年龄、术前血清肌酐值、术前白细胞水平、欧洲心血管手术危险因素评分、体外循环时间、深低温停循环(DHCA)时间、主动脉根部处理、主动脉弓置换、术中及术后24 h输注红细胞量、术后机械通气时间、ICU滞留时间、住院时间、院内死亡率等方面差异有统计学意义。多因素分析显示,术前血清肌酐值、术前白细胞水平、体外循环时间和术中及术后24 h输注红细胞量是术后AKI的独立危险因素。结论术前血清肌酐值、术前白细胞水平、体外循环时间和术中及术后24 h输注红细胞量是急性Stanford A型主动脉夹层术后急性肾功能损伤的独立危险因素。临床上可以根据上述危险因素采取相应的预防措施,保护肾脏功能,降低围术期死亡率。     

急性Stanford A型主动脉夹层术后凝血功能障碍危险因素分析

目的识别急性Stanford A型主动脉夹层术后凝血功能障碍的围术期独立危险因素,为改善患者预后提供科学依据。方法回顾性分析2013~2014年12月北京安贞医院急性Stanford A型主动脉夹层并行急诊手术95例患者的临床资料。根据手术结束时血栓弹力图凝血综合指数(TEG-CI)将患者分为2组。患者手术结束时TEG-CI≤–3时纳入低凝组(n=17例,平均年龄48.70岁),而患者手术结束时TEG-CI–3时纳入对照组(n=78例,平均年龄46.80岁)。应用多因素logistic回归分析鉴定术后发生凝血功能障碍的围术期独立预测因子。结果低凝组术后24 h引流量多于对照组(P=0.008)。术毕活化部分凝血活酶时间(OR=0.011,95%CI0.001~0.021,P=0.035),术毕纤维蛋白原降解产物(OR=0.004,95%CI 0.001~0.007,P=0.022),术毕血小板计数(PLC,×109/L)(OR=–0.002,95%CI–0.003~0.000,P=0.049)与术后凝血功能障碍显著相关。术毕PLC与术后凝血功能障碍曲线拐点为PLC 137.00×109/L。结论临床和实验室检查数据可以提示急性Stanford A型主动脉夹层患者术后凝血功能障碍。术毕活化部分凝血活酶时间、术毕纤维蛋白原降解产物和术毕PLC是其独立危险因素。术后及时、充分补充促凝血药物和抗纤溶药物,新鲜冰冻血浆和血小板可有效改善急性主动脉夹层术后的凝血功能障碍,减少术后出血,从而改善预后。     

Stanford A型主动脉夹层患者术后谵妄的危险因素分析

目的分析Stanford A型主动脉夹层患者术后谵妄的危险因素。方法回顾性分析广东省心血管病研究所2012年1月至2014年12月行手术治疗的A型主动脉夹层335例患者的临床资料,其中男280例、女55例,年龄(48.5±10.3)岁。根据患者术后是否出现谵妄,分为谵妄组与对照组,研究术后谵妄发生的独立危险因素。结果全组发生谵妄共169例,发生率为50.4%。单因素及logistic多因素分析结果显示,术前D二聚体水平(OR=2.480,95%CI 1.347~4.564,P0.01)、术中最低平均动脉压(OR=0.667,95%CI 0.612~0.727,P0.01),术后机械通气时间(OR=2.771,95%CI 1.506~5.101,P0.01),术后急性肾功能衰竭(OR=1.911,95%CI 1.065~3.430,P0.05)是Stanford A型主动脉夹层患者术后谵妄的独立危险因素。结论术后谵妄在Stanford A型主动脉夹层术后患者中有较高的发生率。术前D二聚体升高、术中平均动脉压过低、术后机械通气时间延长、合并急性肾功能衰竭的患者,术后谵妄的发生率明显升高。认识上述危险因素,积极干预可控因素,对减少术后谵妄的发生具有积极的意义。     

Stanford A型主动脉夹层术后急性肾功能损伤危险因素分析及预后

目的比较Stanford A型主动脉夹层术后发生急性肾功能损伤和未发生急性肾功能损伤两组病人的预后,分析发生急性肾功能损伤的高危因素。方法 2014年5月～2016年5月Stanford A型夹层术后发生急性肾功能损伤75例为病例组,按照年龄和体重1:1匹配75例肾功能正常病人作为对照组,分析发生急性肾功能损伤的高危因素,比较两组预后。结果急性肾功能损伤组较未发生组早期并发症率增加1.9倍,肺部感染率增加1.7倍。随访3年,随访率97.0%,平均随访28个月。急性肾功能损伤组病人术后1个月、12个月、24个月及36个月免于远期并发症生存率明显低于未发生组(94.2%、91.2%、80.5%和26.4%比100%、98.6%、91.5%和77.8%,Log-rank P0.01)。围术期大剂量血管活性药(OR=3.455,95%CI:1.163～10.265)和静力型肾血管受损(OR=8.726,95%CI:2.149～35.426)是导致Stanford A型夹层术后发生急性肾功能损伤的高危因素。结论 Stanford A型主动脉夹层手术风险大,围术期大剂量血管活性药和静力型肾血管受损是术后并发急性肾功能损伤的独立高危因素,术后发生急性肾功能损伤病人预后相对较差,积极预防胜过治疗。     

急性Stanford A型主动脉夹层术后患者院内早期死亡危险因素分析

目的 探究急性Stanford A型主动脉夹层并急诊行手术治疗患者在院期间早期死亡的危险因素.方法 回顾性收集2017年1月至2020年1月期间就诊于新疆医科大学第一附属医院诊断为急性Stanford A型主动脉夹层并于入院24 h内急诊行手术治疗患者共189例,其中男160例、女29例,年龄(46.35±9.17)岁...     

Stanford A型主动脉夹层术后急性肾损伤的影响因素

目的 探讨Stanford A型主动脉夹层术后发生急性肾损伤(AKI)的影响因素.方法 2009年9月至2011年12月,176例Stanford A型主动脉夹层患者中男115例,女61例;年龄28 ～75岁,平均(43.20±10.14)岁.手术采用深低温停循环选择性脑灌注技术.采用AKI网络推荐标准,按照术后是否发生AKI分为AKI组78例和非AKI组98例.分析两组围手术期的各项指标,总结AKI发生的相关因素.结果 本组术后AKI发病率44.32％(78/176例),其中21例需要肾脏替代治疗.住院期间死亡6例,住院病死率3.41％.AKI组死亡5例,非AKI组死亡1例.与非AKI组相比,AKI组死亡风险增加5.28倍(P＜0.01).结论 年龄每增加10岁、术前肾功能不全、左心功能不全、CPB＞ 140 min是Stanford A型主动脉夹层术后发生AKI的独立危险因素,应加强围手术期肾功能保护.     

Stanford A型主动脉夹层患者术后发生谵妄的危险因素

目的 探索Stanford A型主动脉夹层患者术后发生谵妄的危险因素。方法 收集2019年9月至2022年6月于南京医科大学第一附属医院接受手术治疗的127例Stanford A型主动脉夹层患者的临床资料,根据术后是否发生谵妄将患者分为谵妄组（n=45）和对照组（n=82）。比较两组患者的手术情况及术后重症监护情况,分析Stanford A型主动脉夹层患者术后发生谵妄的危险因素。结果 谵妄组患者的手术时间、体外循环时间及深低温停循环时间均明显长于对照组患者,差异均有统计学意义（P<0.01）。单因素分析结果显示,谵妄组患者的年龄、高血压患者比例、脑卒中史患者比例、术前D-二聚体水平均高于对照组（P<0.05）。多因素分析结果显示,年龄≥60岁、高血压、脑卒中史、手术时间>6 h、体外循环时间>3 h及深低温停循环时间>40 min均是Stanford A型主动脉夹层患者术后发生谵妄的独立危险因素（P<0.05）。结论 Stanford A型主动脉夹层患者术后谵妄的发生率较高,其与患者年龄、高血压、有脑卒中史、手术时间、体外循环时间及深低温停循环时间均...     

急性主动脉夹层确诊时间延长的危险因素分析

目的 分析急性主动脉夹层（AAD）确诊时间延长的危险因素。方法 收集2021年3月至2023年3月在中国人民解放军南部战区总医院接受诊治的188例AAD患者的临床资料,根据发病至确诊的时间将患者分为延迟组（n=57,﹥12 h）和及时组（n=131,≤12 h）。收集并比较两组患者的既往病史资料、发病时的基本信息,包括年龄、性别、文化程度、婚育状态、工作状态、发病地点、就诊途径、症状、体征、急诊化验结果、检查结果等。采用多因素Logistic回归模型分析AAD确诊时间延长的危险因素。结果 延迟组患者的年龄、高中以下文化程度的比例、家中发病的比例、自行就诊的比例、无痛的比例及合并呼吸困难的比例均高于及时组患者,差异均有统计学意义（P﹤0.05）。多因素Logistic回归分析结果显示,老年（≥65岁）、高中以下文化程度、家中发病、自行就诊、无痛及合并呼吸困难均是AAD确诊时间延长的独立危险因素（P﹤0.05）。结论 年龄、文化程度、发病地点、就诊途径、症状均与AAD确诊时间是否延长有密切的关系,应在急诊工作中强化对AAD的认识,优化AAD疑似患者的就诊流程,并且在临床实践中应对AAD高危...     

Stanford A型主动脉夹层术后死亡和严重并发症的危险因素

目的探讨单中心Stanford A型主动脉夹层(TAAD)患者术后死亡及严重并发症的独立危险因素。方法回顾性分析2012年5月至2015年5月阜外医院行手术治疗341例TAAD患者的临床资料,其中男246例、女95例,平均年龄29~73(47.42±11.54)岁。根据术后有无出现死亡或严重并发症将患者分为两组:并发症组(87例)和无并发症组(254例)。比较分析两组患者围术期资料。结果并发症组患者平均年龄显著高于无并发症组患者[(49.91±11.22)岁vs.(46.57±11.54)岁,P=0.019]。并发症组患者术前出现器官缺血性损伤比例显著高于无并发症组患者:脑缺血(18.4%vs.5.9%,P=0.001)、脊髓损伤(16.1%vs.4.7%,P=0.001)、急性肾损伤(31.0%vs.10.6%,P=0.000)。夹层累及动脉分支血管比例显著高于无并发症组患者:冠状动脉受累(52.9%vs.17.1%,P=0.000)、弓上动脉受累(73.6%vs.53.9%,P=0.001)、腹腔干动脉受累(37.9%vs.22.0%,P=0.003)、肠系膜上动脉受累(18.4%vs.9.8%,P=0.030)、单侧或双侧肾动脉受累(27.6%vs.9.8%,P=0.000)。并发症组体外循环时间、主动脉阻断时间、深低温停循环时间均显著长于无并发症组[(205.05±63.65)min vs.(167.67±50.24)min,(108.11±34.79)min vs.(90.75±27.33)min,(22.55±8.09)min vs.(18.76±9.56)min,P0.05]。年龄、术前合并脑缺血性损伤、术前合并急性肾损伤、术前肢体感觉和(或)运动功能障碍、夹层累及冠状动脉、体外循环时间均为TAAD患者术后死亡和严重并发症发生的独立危险因素;对于夹层累及冠状动脉患者而言,积极同期行冠状动脉旁路移植术可显著降低术后出现并发症的风险,是T A A D患者术后并发症的独立保护性因素[OR=0.167(0.060,0.467),P=0.001]。结论探寻TAAD患者术后各种并发症的高危因素,可为术前识别手术高危人群及术后更加积极预防各种并发症提供重要的临床依据。     

A型主动脉夹层术后急性肾损伤发生的危险因素分析

目的:探讨影响A型主动脉夹层术后急性肾损伤(AKI)发生的影响因素.方法:回顾性分析海军军医大学第一附属医院接受主动脉夹层手术患者的临床资料,共72例接受A型主动脉夹层手术的成年患者,按肾功能水平分为AKI组和肾功能正常组,比较AKI组和肾功能正常组相关临床资料和实验室指标的差异,通过二分类Logistic回归分析,评...     

急性A型主动脉夹层患者术后谵妄的危险因素

目的 分析急性A型主动脉夹层(AAD)患者发生术后谵妄(POD)的相关危险因素。方法 回顾性分析2017年1月至2020年1月术后入ICU监护治疗的AAD手术患者110例,男74例,女36例,年龄≥18岁。根据术后5 d内是否发生POD将患者分为两组：POD组和非POD组。POD的评估采用ICU意识模糊评估法(CAM-ICU)进行。收集患者围术期指标,采用单因素Logistic回归分析AAD手术患者发生POD的相关因素,多因素Logistic回归分析AAD手术患者发生POD的独立危险因素。结果 有32例(29.1%)患者发生POD。单因素Logistic回归分析结果显示,年龄、酗酒史、术前ALT、术后当天急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分、入ICU 6 h内MAP、入ICU 6 h内局部脑氧饱和度(SctO₂)是AAD手术患者发生POD的相关因素(P<0.05)。多因素Logistic回归分析结果显示,年龄增大(每增大1岁,OR=1.240, 95%CI 1.062～1.267,P=0.036)、酗酒史(OR=1.106, 95%CI 0....     

单纯瓣膜置换术后ICU监护时间延长的危险因素分析

目的分析单纯心脏瓣膜置换术后重症监护室留置时间延长的危险因素。方法回顾性分析我院2013年收治的400例单纯瓣膜置换术患者的临床资料,其中男208例、女192例,年龄11~85(50.5±11.1)岁。将所有患者分为两组,其中316例ICU留置时间48 h为A组,84例ICU留置时间≥48 h为B组。记录患者人口学特征、术前、术中以及术后等多种变量,进行单因素和多因素分析。结果两组患者在人口学特征、术前、术中以及术后等多项指标方面差异均有统计学意义(P0.05)。经logistic回归多因素分析发现,如果不纳入术后因素,ICU时间延长和年龄大于70岁(OR 2.024,95%CI 1.182~3.466,P0.05)、心功能分级(NYHA)Ⅲ~Ⅳ级(OR 3.295,95%CI 1.030~10.544,P0.05)、术前血红蛋白浓度小于120 g/L(OR 0.500,95%CI 0.263~0.950,P0.05)、体外循环(CPB)时间180 min(OR 2.486,95%CI 1.006~6.143,P0.05)等4项因素独立相关。如果纳入术后因素,ICU时间延长和CPB时间180 min(OR 3.295,95%CI 1.030~10.544,P0.05)、术后血糖大于10 mmol/L(OR 2.954,95%CI 1.334~6.543,P0.05)、急性肾功能损害(OR 3.141,95%CI 1.406~7.018,P0.05)、手术24 h后拔除气管插管(OR 6.742,95%CI 3.005~15.124,P0.05)等4项因素独立相关。结论心脏瓣膜置换术后ICU监护时间过长和多项术前、术中及术后因素相关,针对这些危险因素特别是术后因素进行预防对缩短ICU监护时间有重要意义。     

A型主动脉夹层术后脑部并发症危险因素分析

Ohjective Retrospectively analyze the risk factors of neurological complications of 160 patients with type A aortic dissection who underwent surgical repalr using cerebral peffusion under deep hypothemia circulatory arrest and to sum the experience of cerebral protection. Methods From January 2004 to January 2006,160 patients with type A dissection underwent surgical repair with cerebral perfusion and DHCA. There were 106 male petients ond 54 female with age from 17 to 76 years old [mean, (56±13) years old]. Antegrade selective cerebral perfusion (SCP) through axillary artery was performad for 131 patients and retrograde cerebra l perfusion (RCP) from superior caval vein for 29 patients. Emergency surgery was perfomed in 83(51.8%) patients who were suf- fered from acute type A dissection, and the others were chronic elective surgery. All the factors underwent univariaare and multivariate analysis. Results Mean cardionpulmonary bypass (CPB) duration was (188± 57) minutes and mean cerebral perfusion time was (36±16) minuties. Sixteen patieats died in hospital and the in-hospital mortality was 10.0%. Deaths were due to multiple argan fail- ure in 9 patients, respiratory failure in 2, low cardiac output syndrome in 2, bloeding in 2, aeptic shock in 1. Postoperative respirato- ry dysfunction were observed in 22 (13.7%) parley. Postoperative renal failure happened in 20(12.5%) patients. Postoperative low cardiac output appeared in 8(5.0%) patients. Penmanent neurological deficits occurred in 8(5.0%) petients. The preopertive renal dysfunction (OR= 11.71, P=0.005), coronary artery disease (OR= 7.35, P =0.035), eet～ml vasenlar disease (OR= 13.39, P=0.021) and postoperative low cardinc ontput (OR=22.21, P=0.008) were found robe the relative risk factor. Tran- sient neurological deficts(TND) were noted in 32 patients. Over seventy years old (OR=1.17, P=0.042) was the independent risk predictors. Surgery procedures, CPB time, cross-clamp time, cerebral perfusion time, methods for cerebral perfusion, filtration used or not, the esophageal temperature and the bladder temperature and the hematocrit (HCT) during CA did not significantly influence the cerebral outcomes.Conclusion In our experience, cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion did not influence the neurological outcomes which depended on the severity of the underlying disease and on the function of end-organs. Protection of all the end-organs would be helpful to the cerebral protection.     

A型主动脉夹层术后肾功能衰竭危险因素分析

目的 分析深低温停循环(DHCA)结合脑灌注下A型主动脉夹层术后肾功能衰竭(RF)的相关危险因素,并探讨肾脏保护措施.方法 2004年1月至2007年10月157例患者在DHCA结合脑灌注下行A型主动脉夹层手术,男性115例,女性42例;年龄17～76岁.129例采用腋动脉插管选择性脑灌注,28例采用上腔静脉逆行性脑灌注.对所有术前、术中相关因素行单因素及多因素分析.结果 平均心肺转流时间(188.0±10.8)min,脑灌注时间(36.0±3.1)min.住院死亡15例(9.6%),永久性神经功能障碍8例(5.1%),术后RF 20例(12.8%).多因素分析示,术前肾功能不全和年龄>70岁是术后RF发生的相关危险因素.术后RF患者其住院死亡率(45%,P=0.001)和永久性神经功能障碍的发生率(25%,P=0.009)远高于其他患者.结论 高龄及术前肾功能不全是A型主动脉夹层术后RF发生的高危因素.     

A型主动脉夹层术后脑部并发症危险因素分析

Ohjective Retrospectively analyze the risk factors of neurological complications of 160 patients with type A aortic dissection who underwent surgical repalr using cerebral peffusion under deep hypothemia circulatory arrest and to sum the experience of cerebral protection. Methods From January 2004 to January 2006,160 patients with type A dissection underwent surgical repair with cerebral perfusion and DHCA. There were 106 male petients ond 54 female with age from 17 to 76 years old [mean, (56±13) years old]. Antegrade selective cerebral perfusion (SCP) through axillary artery was performad for 131 patients and retrograde cerebra l perfusion (RCP) from superior caval vein for 29 patients. Emergency surgery was perfomed in 83(51.8%) patients who were suf- fered from acute type A dissection, and the others were chronic elective surgery. All the factors underwent univariaare and multivariate analysis. Results Mean cardionpulmonary bypass (CPB) duration was (188± 57) minutes and mean cerebral perfusion time was (36±16) minuties. Sixteen patieats died in hospital and the in-hospital mortality was 10.0%. Deaths were due to multiple argan fail- ure in 9 patients, respiratory failure in 2, low cardiac output syndrome in 2, bloeding in 2, aeptic shock in 1. Postoperative respirato- ry dysfunction were observed in 22 (13.7%) parley. Postoperative renal failure happened in 20(12.5%) patients. Postoperative low cardiac output appeared in 8(5.0%) patients. Penmanent neurological deficits occurred in 8(5.0%) petients. The preopertive renal dysfunction (OR= 11.71, P=0.005), coronary artery disease (OR= 7.35, P =0.035), eet～ml vasenlar disease (OR= 13.39, P=0.021) and postoperative low cardinc ontput (OR=22.21, P=0.008) were found robe the relative risk factor. Tran- sient neurological deficts(TND) were noted in 32 patients. Over seventy years old (OR=1.17, P=0.042) was the independent risk predictors. Surgery procedures, CPB time, cross-clamp time, cerebral perfusion time, methods for cerebral perfusion, filtration used or not, the esophageal temperature and the bladder temperature and the hematocrit (HCT) during CA did not significantly influence the cerebral outcomes.Conclusion In our experience, cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion did not influence the neurological outcomes which depended on the severity of the underlying disease and on the function of end-organs. Protection of all the end-organs would be helpful to the cerebral protection.     

A型主动脉夹层术后脑部并发症危险因素分析

Ohjective Retrospectively analyze the risk factors of neurological complications of 160 patients with type A aortic dissection who underwent surgical repalr using cerebral peffusion under deep hypothemia circulatory arrest and to sum the experience of cerebral protection. Methods From January 2004 to January 2006,160 patients with type A dissection underwent surgical repair with cerebral perfusion and DHCA. There were 106 male petients ond 54 female with age from 17 to 76 years old [mean, (56±13) years old]. Antegrade selective cerebral perfusion (SCP) through axillary artery was performad for 131 patients and retrograde cerebra l perfusion (RCP) from superior caval vein for 29 patients. Emergency surgery was perfomed in 83(51.8%) patients who were suf- fered from acute type A dissection, and the others were chronic elective surgery. All the factors underwent univariaare and multivariate analysis. Results Mean cardionpulmonary bypass (CPB) duration was (188± 57) minutes and mean cerebral perfusion time was (36±16) minuties. Sixteen patieats died in hospital and the in-hospital mortality was 10.0%. Deaths were due to multiple argan fail- ure in 9 patients, respiratory failure in 2, low cardiac output syndrome in 2, bloeding in 2, aeptic shock in 1. Postoperative respirato- ry dysfunction were observed in 22 (13.7%) parley. Postoperative renal failure happened in 20(12.5%) patients. Postoperative low cardiac output appeared in 8(5.0%) patients. Penmanent neurological deficits occurred in 8(5.0%) petients. The preopertive renal dysfunction (OR= 11.71, P=0.005), coronary artery disease (OR= 7.35, P =0.035), eet～ml vasenlar disease (OR= 13.39, P=0.021) and postoperative low cardinc ontput (OR=22.21, P=0.008) were found robe the relative risk factor. Tran- sient neurological deficts(TND) were noted in 32 patients. Over seventy years old (OR=1.17, P=0.042) was the independent risk predictors. Surgery procedures, CPB time, cross-clamp time, cerebral perfusion time, methods for cerebral perfusion, filtration used or not, the esophageal temperature and the bladder temperature and the hematocrit (HCT) during CA did not significantly influence the cerebral outcomes.Conclusion In our experience, cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion did not influence the neurological outcomes which depended on the severity of the underlying disease and on the function of end-organs. Protection of all the end-organs would be helpful to the cerebral protection.     

A型主动脉夹层术后脑部并发症危险因素分析

Ohjective Retrospectively analyze the risk factors of neurological complications of 160 patients with type A aortic dissection who underwent surgical repalr using cerebral peffusion under deep hypothemia circulatory arrest and to sum the experience of cerebral protection. Methods From January 2004 to January 2006,160 patients with type A dissection underwent surgical repair with cerebral perfusion and DHCA. There were 106 male petients ond 54 female with age from 17 to 76 years old [mean, (56±13) years old]. Antegrade selective cerebral perfusion (SCP) through axillary artery was performad for 131 patients and retrograde cerebra l perfusion (RCP) from superior caval vein for 29 patients. Emergency surgery was perfomed in 83(51.8%) patients who were suf- fered from acute type A dissection, and the others were chronic elective surgery. All the factors underwent univariaare and multivariate analysis. Results Mean cardionpulmonary bypass (CPB) duration was (188± 57) minutes and mean cerebral perfusion time was (36±16) minuties. Sixteen patieats died in hospital and the in-hospital mortality was 10.0%. Deaths were due to multiple argan fail- ure in 9 patients, respiratory failure in 2, low cardiac output syndrome in 2, bloeding in 2, aeptic shock in 1. Postoperative respirato- ry dysfunction were observed in 22 (13.7%) parley. Postoperative renal failure happened in 20(12.5%) patients. Postoperative low cardiac output appeared in 8(5.0%) patients. Penmanent neurological deficits occurred in 8(5.0%) petients. The preopertive renal dysfunction (OR= 11.71, P=0.005), coronary artery disease (OR= 7.35, P =0.035), eet～ml vasenlar disease (OR= 13.39, P=0.021) and postoperative low cardinc ontput (OR=22.21, P=0.008) were found robe the relative risk factor. Tran- sient neurological deficts(TND) were noted in 32 patients. Over seventy years old (OR=1.17, P=0.042) was the independent risk predictors. Surgery procedures, CPB time, cross-clamp time, cerebral perfusion time, methods for cerebral perfusion, filtration used or not, the esophageal temperature and the bladder temperature and the hematocrit (HCT) during CA did not significantly influence the cerebral outcomes.Conclusion In our experience, cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion did not influence the neurological outcomes which depended on the severity of the underlying disease and on the function of end-organs. Protection of all the end-organs would be helpful to the cerebral protection.     

A型主动脉夹层术后脑部并发症危险因素分析

Ohjective Retrospectively analyze the risk factors of neurological complications of 160 patients with type A aortic dissection who underwent surgical repalr using cerebral peffusion under deep hypothemia circulatory arrest and to sum the experience of cerebral protection. Methods From January 2004 to January 2006,160 patients with type A dissection underwent surgical repair with cerebral perfusion and DHCA. There were 106 male petients ond 54 female with age from 17 to 76 years old [mean, (56±13) years old]. Antegrade selective cerebral perfusion (SCP) through axillary artery was performad for 131 patients and retrograde cerebra l perfusion (RCP) from superior caval vein for 29 patients. Emergency surgery was perfomed in 83(51.8%) patients who were suf- fered from acute type A dissection, and the others were chronic elective surgery. All the factors underwent univariaare and multivariate analysis. Results Mean cardionpulmonary bypass (CPB) duration was (188± 57) minutes and mean cerebral perfusion time was (36±16) minuties. Sixteen patieats died in hospital and the in-hospital mortality was 10.0%. Deaths were due to multiple argan fail- ure in 9 patients, respiratory failure in 2, low cardiac output syndrome in 2, bloeding in 2, aeptic shock in 1. Postoperative respirato- ry dysfunction were observed in 22 (13.7%) parley. Postoperative renal failure happened in 20(12.5%) patients. Postoperative low cardiac output appeared in 8(5.0%) patients. Penmanent neurological deficits occurred in 8(5.0%) petients. The preopertive renal dysfunction (OR= 11.71, P=0.005), coronary artery disease (OR= 7.35, P =0.035), eet～ml vasenlar disease (OR= 13.39, P=0.021) and postoperative low cardinc ontput (OR=22.21, P=0.008) were found robe the relative risk factor. Tran- sient neurological deficts(TND) were noted in 32 patients. Over seventy years old (OR=1.17, P=0.042) was the independent risk predictors. Surgery procedures, CPB time, cross-clamp time, cerebral perfusion time, methods for cerebral perfusion, filtration used or not, the esophageal temperature and the bladder temperature and the hematocrit (HCT) during CA did not significantly influence the cerebral outcomes.Conclusion In our experience, cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion did not influence the neurological outcomes which depended on the severity of the underlying disease and on the function of end-organs. Protection of all the end-organs would be helpful to the cerebral protection.     

A型主动脉夹层术后脑部并发症危险因素分析

目的 对160例在深低温停循环(DHCA)结合脑灌下行A型主动脉夹层手术术后脑部并发症危险因素进行相关分析.方法 160例病人中男106例,女54例;年龄17～76岁,平均(56±13)岁.131例采用腋动脉插管选择性脑灌注(SCP),29例采用上腔静脉逆行性脑灌注(RCP).对所有术前、术中相关因素行单因素及多因素分析.结果 平均体外循环(CPB)(188±57)min,脑灌注(36±16)min.住院死亡16例.8例发生永久性神经功能障碍(PND),多因素分析示,与PND相关的危险因素有术前肾功能不全(OR=11.71,P=0.005)、伴有冠心病(CAD)(OR=7.35,P=0.035)、伴有脑血管病(CVD)OR=13.39,P=0.021)、术后低心排出量综合征(OR=22.21,P=0.008);32例发生暂时性神经功能障碍(TND),年龄>70岁(OR=1.17,P=0.042)是TND的相关危险因素.结论 安全时限内的脑灌注时间、脑灌注方式不影响神经系统并发症,神经系统并发症主要取决于病变本身的严重性和全身各器官功能状态.做好全身各器官的综合保护是脑保护的重要保障.     

A型主动脉夹层术后脑部并发症危险因素分析

Ohjective Retrospectively analyze the risk factors of neurological complications of 160 patients with type A aortic dissection who underwent surgical repalr using cerebral peffusion under deep hypothemia circulatory arrest and to sum the experience of cerebral protection. Methods From January 2004 to January 2006,160 patients with type A dissection underwent surgical repair with cerebral perfusion and DHCA. There were 106 male petients ond 54 female with age from 17 to 76 years old [mean, (56±13) years old]. Antegrade selective cerebral perfusion (SCP) through axillary artery was performad for 131 patients and retrograde cerebra l perfusion (RCP) from superior caval vein for 29 patients. Emergency surgery was perfomed in 83(51.8%) patients who were suf- fered from acute type A dissection, and the others were chronic elective surgery. All the factors underwent univariaare and multivariate analysis. Results Mean cardionpulmonary bypass (CPB) duration was (188± 57) minutes and mean cerebral perfusion time was (36±16) minuties. Sixteen patieats died in hospital and the in-hospital mortality was 10.0%. Deaths were due to multiple argan fail- ure in 9 patients, respiratory failure in 2, low cardiac output syndrome in 2, bloeding in 2, aeptic shock in 1. Postoperative respirato- ry dysfunction were observed in 22 (13.7%) parley. Postoperative renal failure happened in 20(12.5%) patients. Postoperative low cardiac output appeared in 8(5.0%) patients. Penmanent neurological deficits occurred in 8(5.0%) petients. The preopertive renal dysfunction (OR= 11.71, P=0.005), coronary artery disease (OR= 7.35, P =0.035), eet～ml vasenlar disease (OR= 13.39, P=0.021) and postoperative low cardinc ontput (OR=22.21, P=0.008) were found robe the relative risk factor. Tran- sient neurological deficts(TND) were noted in 32 patients. Over seventy years old (OR=1.17, P=0.042) was the independent risk predictors. Surgery procedures, CPB time, cross-clamp time, cerebral perfusion time, methods for cerebral perfusion, filtration used or not, the esophageal temperature and the bladder temperature and the hematocrit (HCT) during CA did not significantly influence the cerebral outcomes.Conclusion In our experience, cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion did not influence the neurological outcomes which depended on the severity of the underlying disease and on the function of end-organs. Protection of all the end-organs would be helpful to the cerebral protection.