主动脉夹层深低温停循环术后并发高钠血症原因分析

目的：探讨主动脉夹层深低温停循环术（deep hypot-hermic circulatory arrest,DHCA）后出现高钠血症的原因。方法：51例主动脉夹层患者均在DHCA下手术,对18例术后出现高钠血症的患者（高钠组）和同期术后血钠正常的33例患者（对照组）的临床资料作回顾性分析,并对两组患者手术前后峰值血钠（Na＋）、空腹血糖（GLU）、剩余碱（BE）、血乳酸含量（Lac）、Scr,术前左心室射血分数（LVEF）,术中体外循环（CPB）时间、主动脉阻断时间、停循环时间,术后甘露醇日平均剂量、神经系统症状、机械通气时间、ICU停留时间、APACHE II评分及相关资料进行比较。结果：高钠组Stanford A型比例及术后神经功能障碍发生率均为88.9%,术后呼吸机辅助时间、ICU停留时间、Lac、甘露醇日平均剂量分别为（102.47±53.62）h、（6.82±2.48）d、4.40（2.15,8.75）mmol/L及（50.77±28.33）g/d,明显高于对照组（P〈0.01）;高钠组CPB时间、主动脉阻断时间、术后GLU、APACHE II评分分别为（213.44±56.22）min、（121.39±38.23）min、（14.31±5.77）mmol/L及（18.15±6.66）分,均高于对照组（P〈0.05）;高钠组术后BE、Scr、停循环时间分别为（-1.03±4.49）mmol/L、（61.67±17.17）μmol/L及（46.17±14.13）min,与对照组比较差异无统计学意义（P〉0.05）。结论：主动脉夹层DHCA术后高钠血症原因与病变复杂、体外循环及主动脉阻断时间长、术后高血糖、乳酸酸中毒、并发神经系统损伤及甘露醇日平均用量过大有关。高钠血症可导致细胞脱水加重病情,应及时给予纠正。

The cause of the patients after aortic dissection opration with hypernatremia under deep hypothermiccirculatory arrest

Objective：To analyze the cause for hypernatremia in patients after aortic dissection surgery under deep hypothermie circulatory arrest（DHCA）. Methods ：51 cases underwent aortic dissection surgery un- der DHCA were retrospectively analyzed. The clinic indexs were compared between observational group with hy- pernatremia （n = 18 ） and control group with normal sodium concentration（ n --33 ）. General conditions, serum sodium and plasma glucose level （GLU）, base excess （BE）, blood lactate concentration（ Lac）, Scr, left ven- tricular ejection fraction（LVEF） , the duration of cardiopulmonary bypass（ CPB ） and aorta block, mechanical ventilation and ICU monitoring time, neurological complications, mannitol average daily dose, APACHE II score were record in perioperative period. Results：In hypernatremia group, the ratio of A type aortic dissection and neurological dysfunction were 88.9% respectively. Ventilation time, ICU monitoring time, Lac, mannitol aver- age daily dose were （ 102.47 ± 53.62 ） h, （ 6. 82 ± 2.48 ） d,4.40 （ 2. 15,8. 75 ） mmol/L, （ 50. 77 ± 28.33 ） g/d respectively. Compared with control group, all above comparisons showed significant difference （P 〈 0. 01 ）. In hypernatremia group, the duration of CPB and aorta block were （213.44 ± 56. 22 ）min and （121.39 ± 38. 23 ）min, GLU and APACHE II score postopration were（ 14. 31 ± 5.77）mmol/L and （18. 15 ＋ 6. 66）scores, which were higher than those in control group （ P 〈 0. 05 ）. BE, Scr and deep hypothermic circulatory arrest time be- tween the two groups had no significant difference （P 〉 0.05 ）. Conclusion：The cause for hypernatremia in pa- tients after aortic dissection surgery under DHCA were connected with A type aortic dissection, longer CPB and aortic clump time, hyperglycemia,lactic acidosis, neurological complications postopration and high-dose manni- to1. Hypernatremia can lead to cell dehydration and aggravate the case＇ s condition, which should be corrected timely.