2018 年第 5 期 第 13 卷

成人主动脉弓部手术后发生短暂性神经功能障碍的危险因素分析

Risk factors of transient neurological dysfunction in adults after aortic arch operation

作者：李海成潘旭东陈彧马倩男郑军刘永民孙立忠郑斯宏

英文作者：

单位：100029首都医科大学附属北京安贞医院心脏外科北京市心肺血管疾病研究所北京市大血管疾病诊疗中心

英文单位：

关键词：主动脉弓部手术；中低温停循环；选择性顺行脑灌注；短暂性神经功能障碍

英文关键词：

• 摘要：

• 目的    分析成人主动脉弓部手术后发生短暂性神经功能障碍（TND）的危险因素。方法    回顾性分析2017年1—9月于首都医科大学附属北京安贞医院应用中低温停循环行主动脉弓部手术的患者159例。根据术后是否发生TND分为发生TND组（52例）与未发生TND组（107例）。比较2组患者术前、术中、术后资料，分析术后TND发生的危险因素。结果    发生TND组患者急性主动脉疾病、急诊手术比例和术前白细胞计数、中性粒细胞百分比、血糖水平和术中体外循环次数、主动脉阻断时间及术后血钠、血糖、血乳酸水平、输入红细胞悬液、使用呼吸机辅助呼吸时间及重症监护病房停留时间明显高于/多于/长于未发生TND组，术后血细胞比容明显低于未发生TND组，差异均有统计学意义（均P＜0.05）。Logistic回归分析结果显示急诊手术（比值比=2.927，95%置信区间：1.326～6.463，P=0.008）、术前血糖水平升高（比值比=1.662，95%置信区间：1.239～2.229，P=0.001）、术中体外循环次数增多（比值比=1.127，95%置信区间：1.012～1.256，P=0.030）是术后TND发生的独立危险因素。结论    急诊手术、术前血糖水平升高、术中体外循环次数增多是术后TND发生的独立危险因素。

• 【Abstract】Objective    To analyze the risk factors of transient neurological dysfunction（TND） in adults after aortic arch operation. Methods    Clinical records of 159 adult patients who had aortic arch operation with moderate hypothermic circulatory arrest from January to September 2017 in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed; TND occurred in 52 patients after operation. Clinical data and operative data were analyzed between TND group（n＝52） and non-TND group（n＝107）; risk factors of TND were analyzed by logistic regression. Results    Acute aortic disease ratio, emergency operation ratio, preoperative leucocyte count, neutrophil percentage, blood glucose level, intraoperative cardiopulmonary bypass times and aortic occlusion time, postoperative blood sodium, blood glucose, blood lactic acid, erythrocyte suspension infusion volume, mechanical ventilation time and intensive care unit stay time in TND group were significantly higher/more/longer than those in non-TND group; postoperative hematocrit in TND group was significantly lower than that in non-TND group（all P＜0.05）. Logistic regression analysis showed that emergency operation［odds ratio（OR）=2.927， 95% confidence interval（CI）： 1.326-6.463， P=0.008］, elevated level of preoperative blood glucose（OR=1.662， 95%CI： 1.239-2.229， P=0.001） and increased times of intraoperative cardiopulmonary bypass（OR=1.127， 95%CI： 1.012-1.256， P=0.030） were independent risk factors of TND. Conclusion    Emergency operation, elevated level of preoperative blood glucose and increased times of intraoperative cardiopulmonary bypass are independent risk factors of TND after aortic arch operation.

  【Key words】Aortic arch operation；Moderate hypothermic circulatory arrest；Selective antegrade cerebral perfusion；Transient neurological dysfunction

  【Fund program】Beijing Science and Technology Project（Z141107002514031）; "Yangfan" Clinical Medical Development Project of Beijing Municipal Administration of Hospitals（ZYLX201503）； Beijing Municipal Administration of Hospitals′ Mission Plan（SML20150601）