急性StanfordA型主动脉夹层术后脑神经系统并发症的危险因素

Risk factors for cerebral neurological injury after operation of acute Stanford type A aortic dissection

目的分析急性StanfordA型主动脉夹层术后脑神经系统并发症的危险因素。方法回顾2005年1月至2011年12月329例急性StanfordA型主动脉夹层行主动脉弓部手术患者的资料，对术后发生的脑神经系统并发症永久性神经系统功能不全（PND）及短暂性神经系统功能不全（TND）的影响因素分别进行单因素分析，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。结果术后发生脑神经系统并发症共77例（23．4％），其中PND11例（3．3％），TND66例（20．1％）。Logistic回归多因素分析显示，年龄（OR=1．087，95％CI1．013～1．166，P=0．020）、脑卒中史（OR=10．383，95％CI1．596～67．534，P=0．014）是PND的独立危险因素。术前血肌酐（OR=1．013，95％CI1．004～1．023，P：0．006）、术前白细胞数（OR=1．199，95％CI1．087～1．324，P=0．000）及术中峰值血糖（OR=1．011，95％CI1．004～1．018，P=0．003）是TND发生的独立危险因素。结论高龄或术前脑卒中史预示术后较高的PND发生率。术前高白细胞水平及术中血糖水平较高预示较高的TND发生率。术中积极控制血糖可能会减少TND的发生。

Objective To analyze risk factors for cerebral neurological injury after operation of acute Stanford type A aortic dissection. Methods Between January 2005 and December 2011, 329 cases of acute Stanford type A aortic dissection patients underwent aortic arch replacement were retrospectively analyzed. Univariate and multivariate analysis（ multiple logistic regression） were used to identify the risk factors for postoperative cerebral neurological injury including permanent neurological dysfunction （PND） and temporary neurological dysfunction（TND）. Results Cerebral neurological injury occurred in 77 cases （23.4%）, PND 11 cases（3.3% ） and TND 66 cases（20.1% ）. Multiple logistic regression showed that age （ OR = 1. 087, 95% CI 1. 013-1. 166, P = 0. 020 ） and stroke history （ OR = 10. 383,95% CI 1. 596 - 67. 534, P = 0. 014 ） were independent risk factors for PND, serum creatinin （ OR = 1. 013,95% CI 1. 004 - 1. 023 ,P =0. 006） , WBC（ OR = 1. 199,95% CI 1. 087 - 1. 324, P = 0. 000 ） and peak intraoperative glucose level （ OR = 1.011 , 95 % CI 1. 004 - 1.018, P = 0. 003 ） were independent risk factors for TND. Conclusion The older age or stroke history indicate the occurrence of PND, Whereas the higher WBC lever preoperative or higher intraoperative glucose level indicate the occurrence of TND. The incidence of TND probably will be reduced by controlling intraoperative hyperglycemia actively.