单、双侧脑灌注在急性A型主动脉夹层术中脑保护效果的临床研究

发布时间：2018-04-20 00:30

本文选题：主动脉夹层 + 双侧脑灌注　；参考：《山东大学》2017年硕士论文

【摘要】：目的对比分析单、双侧选择性脑灌注的技术在急性Stanford A型主动脉夹层行主动脉弓置换手术中脑保护的临床效果,并探究其在术后出现神经系统功能不全并发症的相关危险因素。方法统计分析齐鲁医院心血管外科自2015年1月至2016年12月,庞昕焱手术组同一术者行主动脉弓置换手术治疗的急性Stanford A型主动脉夹层患者的各项病例资料,根据术中停循环阶段选择性脑灌方式上的差别,分成单侧脑灌(USCP)组和双侧脑灌(BSCP)组共两组。分析病例的年龄、体重、术前合并症,手术方式、体外循环(人工心肺旁路)时间、主动脉阻断时间、停循环时间,术后苏醒时间、气管插管带管时间、神经系统功能不全并发症的发生情况及预后转归等患者各项临床资料,并采用Studentt检验、卡方检验和多因素Logistic回归模型进行统计学分析,对比分析单侧脑灌注组和双侧脑灌注组在术后神经系统功能不全等方面的差异,并分析患者的一般情况及术前、术中相关资料与术后神经系统功能不全的关系。结果本研究收录的临床病例资料共计患者114例,其中包括单侧选择性脑灌(USCP)组患者共32例,双侧选择性脑灌(BSCP)组患者共82例。两组患者术后神经系统功能不全的发病率分别为46.88%(TND 28.13%,PND 18.75%)和15.85%(TND 12.20%,PND 3.66%),术后平均苏醒时间分别为 15:11 ± 14:36(h)和9:02±8:07(h),以及术后的治愈好转率分别为81.25%和93.90%,两组患者资料间的对比差异均具有统计学意义(P0.05)。Logistic回归模型分析患者术后神经系统功能不全的相关危险因素为术前神经系统功能不全情况(OR:6.80)、术中脑灌注方式(OR:3.81)和辅助循环时间(OR:1.04)。结论急性Stanford A型主动脉夹层的患者行主动脉弓置换手术治疗:1.术中采用双侧选择性脑灌可有效地减少术后神经系统功能不全并发症的发生,相较于单侧选择性脑灌更加安全、可靠。2.患者的发病类型、术中中低温停循环温度对术后神经系统功能不全并发症的发生有影响。3.术后神经系统功能不全并发症的发生情况对患者的苏醒时间及预后转归有影响。4.术后神经系统功能不全的危险因素为术前神经系统功能状况、术中脑灌注方式和辅助循环时间。
[Abstract]:Objective to compare the clinical effects of unilateral and bilateral selective cerebral perfusion in patients with acute Stanford A aortic dissection undergoing aortic arch replacement, and to explore the risk factors for postoperative complications of neurological insufficiency. Methods from January 2015 to December 2016, the data of patients with acute Stanford A aortic dissection treated by aortic arch replacement in Pang Xinyan group were analyzed. According to the difference of selective cerebral perfusion during circulatory arrest, the patients were divided into two groups: USCP group and BSCP group. Age, body weight, preoperative complications, operative methods, time of CPB (artificial cardiopulmonary bypass), time of aortic occlusion, time of arrest of circulation, time of postoperative recovery, time of tracheal intubation with tube were analyzed. The occurrence and prognosis of complications of nervous system insufficiency were analyzed statistically by Studentt test, chi-square test and multivariate Logistic regression model. To compare and analyze the difference between unilateral cerebral perfusion group and bilateral cerebral perfusion group in postoperative nervous system insufficiency, and to analyze the general situation of patients and the relationship between preoperative and operative data and postoperative nervous system insufficiency. Results 114 patients were included in this study, including 32 patients with unilateral selective cerebral perfusion (USCP) and 82 patients with bilateral selective cerebral perfusion (BSCP). The incidence of postoperative nervous system dysfunction in the two groups were 46.88%(TND 28.13 and PND18.75) and 15.85%(TND 12.20 and PND3.66.The average recovery time after operation was 15:11 卤14: 36hand 9:02 卤8: 07h, respectively, and the cure rate was 81.25% and 93.90%, respectively. The relative risk factors of postoperative nervous system dysfunction were: preoperative neurological insufficiency (OR: 6.80), intraoperative cerebral perfusion mode (OR: 3.81) and auxiliary circulation time (OR: 1.04g). Conclusion Aortic arch replacement is performed in patients with acute Stanford A aortic dissection. Bilateral selective cerebral perfusion can effectively reduce postoperative complications of nervous system insufficiency, which is more safe and reliable than unilateral selective cerebral perfusion. The type of disease, the temperature of hypothermia and circulatory arrest during operation had an effect on the occurrence of postoperative complications of nervous system insufficiency. 3. 3. Postoperative complications of nervous system insufficiency affected the recovery time and prognosis of patients. 4. 4. The risk factors of postoperative neurological dysfunction were preoperative neurological function, intraoperative cerebral perfusion and auxiliary circulation time.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R654.2

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