DeBakeyⅠ型主动脉夹层术后神经系统并发症的探讨

Analysis of neurological complication after type DeBakey Ⅰ aortic dissection

目的探讨DeBakeyⅠ型主动脉夹层术后神经系统并发症的原因和相应预防处理方法。方法70例DeBakeyⅠ型主动脉夹层患者，手术均在深低温停循环、选择性脑灌注下完成。对引起神经系统并发症的原因做统计学分析。结果1例死亡，被排除该研究。体外循环时间（158．39±47．16）min，主动脉阻断时间（99．12±46．27）min，脑部停循环时间（29．83±6．85）min。术后神经系统并发症的发生率为27．5％（19／69），其中永久性神经功能障碍3例，暂时性神经功能障碍10例，截瘫2例，声音嘶哑4例。脑部并发症的危险因素有肝肾功能不全、高血压、主动脉阻断时间〉120min、停循环时间〉40min、输血量〉4000ml、术后血压波动〉80mmHg（1mmHg=0．133kPa）及术后低心排血量综合征（P〈0．05或〈0．01）。结论DeBakeyⅠ型主动脉夹层术后神经系统并发症是多因素共同作用的结果。安全时限内的脑灌注，尽量缩短主动脉阻断和停循环时间，维持循环稳定，改进手术操作，减少输血量，积极处理肝肾功能不全可预防神经系统并发症。

Objective To evaluate the risk factors and of neurological complications after type DeBakey Ⅰ aortic dissection. Methods Seventy patients underwent operations of the aortic dissection with deep hypothermic circulatory arrest （DHCA） in combination with antegrade selective cerebral perfusion （ASCP）. Perioperative factors were evaluated by means of univariate and multivariate logistic analysis to identify relative risk factors of neurological complications. Results One case was exduded. The extracorporeal circulation time was （158.39 ± 47.16） min,the aortic crossclamp time was （99.12 ±46.27） min,the brain stop circulation time was （29.83 ± 6.85 ） min. Neurological complications occurred in 19 patients （27.5%）, including 10 patients with temporary cerebral dysfunction,3 patients with permanent cerebral dysfunction,2 patients with paraplegia,4 patients with hoarseness. Renal and hepatic dysfunction,hypertension disease, aortic crossclamp time 〉 120 min,cireulatory arrest time 〉 40 min, blood transfusion volume 〉 4000 ml, arterial blood pressure instability 〉 80 mm Hg （ 1 mm Hg = 0.133 kPa） and postoperative low cardiac output were the risk factors for cerebral complication （P 〈 0.05 or 〈 0.01 ）. Conclusions No single risk factor explains the onset of neurological complications. Cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion does not influence the neurological complications. Protection of all the endorgans would be helpful to the cerebral protection.