深低温停循环术后短暂神经系统功能不全的危险因素分析

Risk factors for temporary neurological dysfunction after deep hypothermic circulatory arrest operation

目的分析深低温停循环术后短暂神经系统功能不全(TND)的危险因素。方法回顾性分析2005年1月～2011年6月549例行深低温停循环主动脉弓部手术的患者,按照术后是否发生TND分为两组,进行单因素分析,将单因素分析具有统计学差异的变量进行Logistic回归多因素分析。结果术后有83例(15.1%)发生TND,TND组呼吸机时间、ICU时间及住院时间延长。单因素分析显示体重指数、马凡综合征、急性主动脉夹层、高血压病史、术前白细胞(WBC)、血清肌酐、急诊手术、体外循环时间、主动脉阻断时间、低流量时间、术中峰值血糖、术中峰值乳酸和TND发生显著相关。Logistic回归多因素分析显示,术前WBC、血清肌酐、低流量时间及术中峰值血糖是TND发生的独立危险因素。结论术前较高的WBC、血清肌酐预示着术后TND的发生,通过术中控制低流量时间及血糖水平有可能降低TND的发生。

Objective To analyze the risk factors for temporary neurological dysfunction（TND） after under deep hypothermic circulatory arrest operation.Methods Between January 2005 and June 2011,549 cases underwent aortic arch replacement with deep hypothermic circulatory arrest were retrospectively analyzed.According to the occurrence of TND,they were divided into two groups.Univariate and multivariate analysis（multiple logistic regression） were used to identify the risk factors.Results TND occurred in 83 cases（15.1%）.Univariate analysis showed that body mass index,Marfan syndrome,acute aortic dissection,hypertension,white blood cell（WBC）,serum creatinine,emergency operation,cardiopulmonary bypass time,aortic cross-clamp time,low-flow perfusion time,the peak intraoperative glucose level and the peak intraoperative blood lactate related to TND significantly.Multiple logistic regression showed that preoperative WBC,serum creatinine and the peak intraoperative glucose level were independent risk factors for TND.Conclusion The higher preoperative WBC and serum creatinin level maybe indicate the occurrence of TND,while controlling low-flow perfusion time and intraoperative hyperglycemia maybe can reduce the incidence of TND.