围手术期亚低温干预对急性A型主动脉夹层患者术后神经系统预后的影响

Impact of perioperative mild hypothermia on neurological function and prognosis of patients with acute type A aortic dissection

目的 探讨围手术期亚低温干预对急性A型主动脉夹层患者神经系统功能及预后的影响.方法 纳入2017年2月至2018年2月南京市第一医院重症医学收治的拟行外科手术治疗的急性A型主动脉夹层患者65例,按照随机数字法随机分为亚低温组和对照组.术中经历深低温停循环后,亚低温组患者复温至鼻咽温34℃~35℃并维持至术后24 h;对照组患者复温至鼻咽温36℃,术后给予常规复温治疗.术前记录患者一般临床资料,术后记录两组患者的神经系统功能及预后相关指标.同时,所有患者术前、术后 1、6、12、24 h抽取外周静脉血,采用ELISA法检测血清中S 100β和神经元特异性烯醇化酶(neuron-specific enolase,NSE)的水平.结果 与对照组相比,亚低温组术后苏醒时间明显缩短[10.6 h(IQR:7.6,19.1)对25.8 h(IQR:13.3,54.2),P=0.007],术后 1、6 h的NSE水平以及术后 1、6、12、24 h的S 100β的水平显著低于对照组(P<0.05),住院时间明显缩短[19天(IQR:17,23)对24天(IQR:17,28),P=0.036].两组患者在谵妄及脑血管意外的发生率方面差异无统计学意义.结论 围手术期亚低温干预可以明显减轻急性A型主动脉夹层患者的神经细胞损伤,缩短患者的术后苏醒时间及住院时间,改善患者预后.

Objective To investigate the impact of perioperative mild hypothermia on the neurological function and prog-nosis of patients with acute type A aortic dissection. Methods This study enrolled 65 patients with acute aortic dissection un-derwent surgery during the period of February 2017 to February 2018 and randomly divided them into mild hypothermia group and control group. After the process of deep hypothermic circulatory arrest,patients in the mild hypothermia group were re-warmed to 34 ℃ - 35 ℃ and maintained until 24 h after the operation. While,the patients in the control group were rewarmed to 36 ℃ and were treated with routine rewarm therapy. Baseline characteristics were recorded before the operation and neuro-logical and prognosis related indexes were recorded after the operation for all the patients. At the same time,peripheral venous bloods of all the patients were collected preoperatively and at 1、6、 12 and 24 h after the operation. Serum S 100β and neuron-specific enolase(NSE)levels were measured by ELISA kit. Results Compared with the control group,patients in the mild hypothermia group had a significantly shorter recovery time[ 10. 6 h(IQR:7. 6, 19. 1)vs. 25. 8 h(IQR: 13. 3,54. 2),P =0. 007]. At the same time,serum levels of NSE at 1 h and 6 h after operation and serum levels of S 100β levels at 1、6、 12 and 24 h after operation in the mild hypothermia group were significantly lower than those in the control group(P < 0. 05). In addi-tion,the length of stay in the mild hypothermia group was significantly shorter than that in the control group[ 19 days(IQR: 17, 23)vs. 24 days(IQR: 17,28),P = 0. 036]. However,there was no statistically difference in the incidence of delirium and cerebrovascular accidents between the two groups. Conclusion Perioperative mild hypothermia therapy can significantly re-duce brain cell damage in the patients with acute type A aortic dissection and can shorten postoperative recovery time and hospi-talization time,and thus improve the prognosis of patients.