65例StanfordA型主动脉夹层患者在不同温度下手术的效果分析

Effective analysis of sixty-five patients with Stanford type A aortic dissection operated under different cooling tempera ture

目的分析不同温度对Stanford A型主动脉夹层手术后效果的影响。方法回顾2007年4月至2012年3月65例接受主动脉根部成形加升主动脉置换加主动脉弓替换加支架象鼻术的StanfordA型主动脉夹层患者的临床资料。根据术中降温程度不同分为A、B两组，A组温度控制在20℃-24℃；B组温度控制在25℃-28℃。对比分析体外循环时间、术后引流量、呼吸机使用时间、术后脑部并发症的发生率等指标。结果两组术中体外循环时间、停循环时间、术后引流量、呼吸机使用时间以及术后短暂性神经系统功能障碍的发生率比较差异有统计学意义。术后永久性神经系统功能障碍的发生率、连续性肾脏替代治疗的使用以及术后死亡比例方面比较组间差异无统计学意义。结论低温停循环手术中，在保证熟练的手术操作的前提下，适当提高降温水平是安全的，也可以在一定程度上减小对患者身体的创伤，缩短手术时间和患者恢复时间，减少用血量，减少并发症。

Objective To comparatively analyze effect of different cooling temperature on postoperative results of pa- tients with Stanford type A aortic dissection underwent surgical treatment. Methods Clinical data of 65 patients with Stanford type A aortic dissection performed aortic root shaping, ascending aorta and total aortic arch replacement combined with stented elephant trunk technique from April 2007 to March 2012 were retrospectively analyzed. According to the cooling temperature, the patients were divided into two groups： group A and group B. The coaling temperature was 20 ℃ to 24 ℃ in group A and 25℃ to 28 ℃ in group B. E.xtracorporeal circulation time, circulatory arrest periods, volume of postoperative drainage, venti- lation time and cerebral complications incidence after operation were analyzed contrastively. Results There was significant difference between two groups about extracorporeal circulation time, circulatory arrest periods, volume of postoperative drain- age, ventilationtime and transient neurological dysfunction（TND） incidence after operation. There was no significant difference between two groups in postoperative permanent neurological dysfunction （ PND）, use of continuous renal replacement therapy （CRRT） and mortality. Conclusion It is safe to appropriately increase the standard of cooling temperature through operating skillfully under the circumstance of deep hypothermic circulatory arrest, h, to some extent, shortens operating time and decrea- ses injuries on patients, time of recovery, volume of blood transfusion and complications.