| 韩冬,孙君隽,张超.三种脑灌注方案对行深低温停循环 Stanford A型主动脉夹层病人围手术期临床指标、神经系统功能障碍发生率及心率变异性水平的影响[J].安徽医药,2020,24(11):2229-2233. |
| 三种脑灌注方案对行深低温停循环 Stanford A型主动脉夹层病人围手术期临床指标、神经系统功能障碍发生率及心率变异性水平的影响 |
| Influence of three kinds of cerebral perfusion schemes on perioperative clinical indicators，ND incidence and HRV levels of patients with Stanford A type aortic dissection by DHCA |
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| DOI：10.3969/j.issn.1009?6469.2020.11.028 |
| 中文关键词: 主动脉瘤，胸/外科学 脑灌注 深低温停循环 Stanford A型主动脉夹层 疗效 |
| 英文关键词: Aortic aneurysm,thoracic/surgery Cerebral perfusion DHCA Stanford A type aortic dissection Clinical effect |
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| 中文摘要: |
| 目的探讨上腔静脉逆行脑灌注、顺行单侧脑灌注及改良顺行双脑灌注方案对行深低温停循环(DHCA)Stanford A型主动脉夹层病人围手术期临床指标、神经系统功能障碍(ND)发生率及心率变异性(HRV)水平的影响。方法选取 2011年 5月至 2018年 3月南阳市中心医院收治行 DHCA Stanford A型主动脉夹层病人共 120例，其中 A组(40例)采用上腔静脉逆行脑灌注治疗， B组(40例)采用顺行单侧脑灌注治疗， C组(40例)采用改良顺行双脑灌注方案治疗，比较三组围手术期临床指标水平， ND发生率、 HRV指标水平及死亡率。结果 A、B、C三组病人手术时间［(7.58±1.57)比(7.42±1.43)比(7.19±1.33)h］、体外循环时间［(192.39±35.47)比(188.42±32.49)比(184.80±30.21)min］、降温时间［(46.58±6.22)比(44.20±5.98)比(43.46±5.69) min］、复温时间［(93.80±22.17)比(92.39±21.36)比(92.06±12.28)min］及气管切开率(12.50%比 10.00%比 7.50%)比较，差异无统计学意义(P＞0.05)； A、B、C三组脑灌注时间［(42.71±7.95)比(33.20±5.18)比(30.94±4.75)min］、辅助呼吸时间［(37.80± 4.65)比(30.59±3.97)比(27.06±3.90)h］、 ICU停留时间［(6.36±1.10)比(4.92±0.92)比(4.20±0.68)h］及术后住院时间［(18.44± 3.30)比(14.10±2.69)比(12.86±2.54)d］比较， C组均显著少于 A组、 B组(P＜0.05)；三组短暂性神经系统功能障碍(TND)发生率比较， C组(10.00%)均显著低于 A(42.50%)、 B组(20.00%)(P＜0.05)；三组永久性神经系统功能障碍(PND)发生率比较差异无统计学意义(P＞0.05)； B、C组全部窦性 R?R间期标准差(SDNN)、 24 h内每 5 min时段窦性 R?R间期均数的标准差(SDANN)、 24 h内全部窦性 R?R间期差值的均方根值(rMSSD)及 24 h内两个相邻 R?R间期互差＞ 50 ms的心跳数所占分析信息间期内心搏数的百分比(PNN50)水平均显著高于 A组(P＜0.05)； A组、 B组及 C组病人死亡率分别为 2.50%(1/40)0.00%(0/40)0.00%(0/40)，差异无统计学意义(P＞0.05)。结论改良顺行双脑灌注方案用于行DHCAStanfordA型主动脉夹层，病人可有效，缩短脑灌注用时，加快术后康复进程，避免神经功能损伤发生，并有助于降低心率变异性，价值优于上腔静脉逆行和顺行单侧脑灌注。 |
| 英文摘要: |
| Objective To investigate the influence of retrograde cerebral perfusion，selective unilateral antegrade cerebral perfusionand improved bilateral cerebral antegrade perfusion on perioperative clinical indicators，nervous dysfunction(ND)incidence and heart rate variability(HRV)levels of patients with Stanford A type aortic dissection by Deep hypothermic circulatory arrest(DH? CA).Methods A total of 120 patients with Stanford A type aortic dissection by DHCA admitted to Central Hospital of Nanyangfrom May 2011 to March 2018 were chosen and divided into 3 groups including A group(40 patients)with retrograde cerebral per? fusion，B group(40 patients)with selective unilateral antegrade cerebral perfusion and C group(40 patients)with improved bilat? eral cerebral antegrade perfusion.The levels of perioperative clinical indicators，ND incidence，levels of HRV ralated index and mor? tality of the 3 groups were compared.Results There was no significant difference in the operation time［(7.58±1.57)vs.(7.42±1.43)vs.(7.19±1.33)h］cardiopulmonary bypass time［(192.39±35.47)vs.(188.42±32.49)vs.(184.80±30.21)min］，temperaturefall time［(46.58±6.22)vs(44.20±5.98)vs.(43.46±5.69)min］，rewarming time［(93.80±22.17)vs.(92.39±21.36)vs.(92.06± 12.28)min］and tracheotomy rate(12.50% vs. 10.00% vs. 7.50%)between A，B and C group(P＞0.05).As for the cerebral perfu? sion time［(42.71±7.95)vs.(33.20±5.18)vs.(30.94±4.75)min］auxiliary breathing time［(37.80±4.65)vs.(30.59±3.97)vs.(27.06±3.90)h］， ICU residence time［(6.36±1.10)vs.(4.92±0.92vs.(4.20±0.68)h］and postoperative hospital staying time［(18.44±3.30)vs.(14.10±2.69)vs.(12.86±2.54)d］of A，B and C group，those in C group were significantly shorter than those in A and B group(P＜0.05).The temporary nervous dysfunction(TND)incidence of C group(10.00%)were significantly lower than that in A group(42.50%)and B group(20.00%)(P＜0.05).There was no significant difference in the permanent nervous dysfunc? tion(PND)incidence among the 3 groups(P＞0.05).The levels of SDNN，SDANN，rmSSD and PNN50 of B and C group were sig? nificantly higher than those in A group(P＜0.05).There was no significant difference in the mortality among the 3 groups［2.50%(1/40)，0.00%(0/40)，0.00%(0/40)，P＞0.05］.Conclusion Compared with retrograde cerebral perfusion and selective unilateral antegrade cerebral perfusion，improved bilateral cerebral antegrade perfusion in the treatment of patients with Stanford A type aorticdissection by DHCA can efficiently shorten the cerebral perfusion time，speed up postoperative rehabilitation，avoid neurological im? )，pairment and be helpful to reduce heart rate variability. |
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