深低温停循环主动脉弓部手术后苏醒延迟危险因素分析

Risk factors of the delayed recovery after aortic arch surgery under deep hypothermic circulatory arrest

目的探讨在深低温停循环（deephypothermie circulatoryarrest，DHCA）选择性脑灌注（antegrade selective cerebralperfusion，ASCP）下行主动脉弓部手术后发生苏醒延迟的危险因素。方法回顾性分析2006年10月至2013年6月期间南京市鼓楼医院97例行主动脉弓部手术患者的临床资料。97例患者分为两组：正常组（46例），男37例，女9例，平均年龄（48＋11）岁；苏醒延迟组（51例），男40例，女11例，平均年龄（52±11）岁。观察两组患者的临床资料，采用单因素方差分析和Logistic多因素回归分析导致患者术后发生苏醒延迟的危险因素。结果97例患者中术后发生苏醒延迟51例（52．58％），其中11例患者（11．34％）术后一直未醒，住院死亡20例（20．62％）。单因素分析结果显示：年龄（P=-0．047）、高血压病史（P=0．005）、急诊手术（降0．031）、体外循环（eardiopulmonarybypass，CPB）时间（P=0．017）、心肌阻断时间（P=O．021）、输血（P=O．001）是DHCAASCP术后发生苏醒延迟的危险因素。Logistic回归分析结果显示：急诊手术（P=0．005）、CPB时间〉240min（P〈0．001）是导致DHCAASCP术后发生苏醒延迟的独立危险因素。结论主动脉弓部手术后发生苏醒延迟是多因素共同作用的结果。

Objective To determine the risk factors of delayed recovery following aortic arch surgery under deep hypothermic circulatory arrest （DHCA） in combination with antegrade selective cerebral perfusion （ASCP）. Methods We retrospectively analyzed the clinical data of 97 patients who underwent aortic arch surgery under DHCA＋ASCP between September 2004 and June 2013 in Nanjing Drum Tower Hospital. The patients were divided into two groups according to whether the consciousness recovered in 24 h after the operation. In the normal group （n=46）, there were 37 males and 9 females with an average age of （48＋11 ） y. In the delayed recovery group （n=51 ）, there were 40 males and 11 females with an average age of （52＋ 11 ） y. We observed the clinical data of the patients in both groups and the risk factors of delayed recovery after aortic arch surgery were evaluated by single factor analysis and multivariate logistic regression analysis. Results Among all the patients, delayed recovery occurred in 51 （52.58%）, 11 （ 11.34% ） of whom had been continuously unawakened. Hospital mortality is 20.62%. Advanced age （〉 60 ） （P=0.030）, hypertension disease （P=0.005）, emergency surgery （P=0.031 ）, cardiopulmonary bypass （ CPB ） time 〉240 min （ P= 0.017）, aortic cross-clamp time〉180 min （P=0.021） and blood transfusion of RBC suspension〉21 U are the risk factors for delayed recovery. Emergency surgery （P=0.005） and CPB time〉240 min （P〈0.001） are independent determinants for delayed recovery. Conclusions No single risk factor explained the onset of delayed recovery. Rather, a combination of factors, especially emergency surgery and longer CPB time produced the highest odds of deficit.