A型主动脉夹层术后脑部并发症危险因素分析 |
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引用本文: | 罗海燕,胡克俭,刘祖赟,程玥,赵赟,潘荪,赵强,王春生. A型主动脉夹层术后脑部并发症危险因素分析[J]. 中华胸心血管外科杂志, 2003, 25(1): 148-150. DOI: 10.3760/cma.j.issn.1001-4497.2009.03.003 |
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作者姓名: | 罗海燕 胡克俭 刘祖赟 程玥 赵赟 潘荪 赵强 王春生 |
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作者单位: | 2111032,上海,复旦大学附属中山医院心外科; |
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基金项目: | 上海市重点学科建设项目 |
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摘 要: | 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.
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关 键 词: | 动脉瘤 夹层 体外循环 手术后并发症 危险因素 神经系统疾病 |
Analysis of risk factors of postoperative of type A aortic dissection |
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Abstract: | |
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Keywords: | Aneueysmdissecting Extracorporesl circulation Postoperative complications Risk factors Ner- vous system diseases |
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