依达拉奉联合乌司他丁对A型主动脉夹层全弓置换术患者的脑保护作用
发布时间：2018-12-28 20:01
【摘要】：目的:观察依达拉奉联合乌司他丁对A型主动脉夹层(AAD)全弓置换术患者的脑保护作用。方法:前瞻性分析2014-09至2016-01于我中心连续收治行全弓置换术治疗的AAD患者60例。将围术期使用依达拉奉和乌司他丁的30例患者为用药组,用药方法:(1)入院至术后3天:乌司他丁30万U/8 h,依达拉奉0.5mg/(kg·12 h);(2)体外循环中:乌司他丁30万U/2 h,依达拉奉0.5 mg/kg;未使用依达拉奉和乌司他丁的30例患者为非用药组。观察指标:(1)术中:手术时间、体外循环时间、选择性顺行脑灌注时间、心脏停搏时间、最低直肠温度以及双侧选择性顺行脑灌注(BACP)、单侧选择性顺行脑灌注(UACP)例数;(2)脑损伤血液检测指标:两组患者于切皮时(T0)、开放主动脉时(T1)、停转流时(T2)、术后入重症监护病房时(T3)、术后24 h(T4)、术后3d(T5)时S-100和神经元特异性烯醇化酶(NSE)水平;(3)术后临床指标:住院时间、机械通气时间、中国临床神经功能缺损程度评分量表(CSS)评分、永久性神经功能缺损(PND)、一过性神经功能缺损(TND)例数和院内死亡例数。结果:用药组和非用药组患者在手术时间、体外循环时间、心脏停搏时间、选择性顺行脑灌注时间、BACP和UACP方式选择、术中最低直肠温度差异无统计学意义。两组患者T0时相S-100和NSE差异无统计学意义;与非用药组比较,用药组术后T1至T5时相S-100和NSE较低(P0.05)。两组患者住院时间,手术后机械通气时间、PND和TND发生例数、出院前CSS评分中型以上神经功能障碍≥16分的例数和院内死亡例数差异无统计学意义(P均0.05)。结论:依达拉奉联合乌司他丁对AAD行全弓置换术患者有脑保护作用,能降低脑损伤血液特异指标表达,但是否具有临床意义有待进一步研究。
[Abstract]:Aim: to observe the brain protective effect of Edaravone combined with ulinastatin on patients with type A aortic dissection undergoing (AAD) total arch replacement. Methods: a prospective analysis of 60 patients with AAD underwent total arch replacement from 2014-09 to 2016-01 in our center. 30 patients who were treated with Edaravone and ulinastatin during perioperative period were treated with: (1) admission to 3 days after operation: ulinastatin 300000 U / 8 h, Edaravone 0.5mg/ (kg 12 h);) (2) during cardiopulmonary bypass, 30 patients with ulinastatin 300000 U / 2 h and Edaravone 0.5 mg/kg; without Edaravone and ulinastatin were not treated. Outcome measures: (1) Intraoperative: operative time, cardiopulmonary bypass time, selective anterograde cerebral perfusion time, cardiac arrest time, minimum rectal temperature and bilateral selective anterograde cerebral perfusion (BACP), Cases of unilateral selective anterograde cerebral perfusion with (UACP); (2) Blood index of brain injury: two groups of patients were treated at incision (T 0), aorta opening (T 1), bypass arrest (T 2), admission to intensive care unit (T 3), 24 h after operation (T 4). The levels of S-100 and neuron-specific enolase (NSE) were observed 3 days after operation (T5). (3) postoperative clinical indicators: duration of hospitalization, time of mechanical ventilation, (CSS) score of Chinese clinical neurological impairment scale, (PND), of permanent neurological impairment The number of patients with transient neurological impairment (TND) and nosocomial death. Results: there was no significant difference in operation time, cardiopulmonary bypass time, cardiac arrest time, selective anterograde cerebral perfusion time, choice of BACP and UACP mode, and the lowest rectal temperature during operation. There was no significant difference in S-100 and NSE between the two groups at T0, and the levels of S-100 and NSE at T1 to T5 after operation were lower in the treated group than in the non-medication group (P0.05). There was no significant difference between the two groups in the hospitalization time, the time of mechanical ventilation after operation, the occurrence of PND and TND, the number of patients with neurological dysfunction 鈮，
本文编号：2394369
[Abstract]:Aim: to observe the brain protective effect of Edaravone combined with ulinastatin on patients with type A aortic dissection undergoing (AAD) total arch replacement. Methods: a prospective analysis of 60 patients with AAD underwent total arch replacement from 2014-09 to 2016-01 in our center. 30 patients who were treated with Edaravone and ulinastatin during perioperative period were treated with: (1) admission to 3 days after operation: ulinastatin 300000 U / 8 h, Edaravone 0.5mg/ (kg 12 h);) (2) during cardiopulmonary bypass, 30 patients with ulinastatin 300000 U / 2 h and Edaravone 0.5 mg/kg; without Edaravone and ulinastatin were not treated. Outcome measures: (1) Intraoperative: operative time, cardiopulmonary bypass time, selective anterograde cerebral perfusion time, cardiac arrest time, minimum rectal temperature and bilateral selective anterograde cerebral perfusion (BACP), Cases of unilateral selective anterograde cerebral perfusion with (UACP); (2) Blood index of brain injury: two groups of patients were treated at incision (T 0), aorta opening (T 1), bypass arrest (T 2), admission to intensive care unit (T 3), 24 h after operation (T 4). The levels of S-100 and neuron-specific enolase (NSE) were observed 3 days after operation (T5). (3) postoperative clinical indicators: duration of hospitalization, time of mechanical ventilation, (CSS) score of Chinese clinical neurological impairment scale, (PND), of permanent neurological impairment The number of patients with transient neurological impairment (TND) and nosocomial death. Results: there was no significant difference in operation time, cardiopulmonary bypass time, cardiac arrest time, selective anterograde cerebral perfusion time, choice of BACP and UACP mode, and the lowest rectal temperature during operation. There was no significant difference in S-100 and NSE between the two groups at T0, and the levels of S-100 and NSE at T1 to T5 after operation were lower in the treated group than in the non-medication group (P0.05). There was no significant difference between the two groups in the hospitalization time, the time of mechanical ventilation after operation, the occurrence of PND and TND, the number of patients with neurological dysfunction 鈮，
本文编号：2394369
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