Stanford A型主动脉夹层弓部置换体外循环术后延迟苏醒危险因素分析

Analysis of Risk Factors of Delayed Recovery after Bow Replacement Extracorporeal Circulation Operation for Patients with Stanford A Aortic Dissection

目的:回顾性分析288例Stanford A型主动脉夹层患者在体外循环(CPB)下行弓部置换手术延迟苏醒的相关危险因素。方法:对所有病例用深低温停循环(DHCA)选择性顺行脑灌(SACP)治疗主动脉夹层弓部置换的临床资料进行分析,根据术后24h苏醒情况分为术后意识恢复正常组和术后延迟苏醒组,用Logistic回归分析术后发生延迟苏醒的独立危险因素。结果:SACP时间、术中最高乳酸值及术后白细胞(WBC)计数为患者术后延迟苏醒的独立危险因素。结论:Stanford A型主动脉夹层弓部置换术后延迟苏醒是多因素的共同结果,临床上应减少SACP时间,降低乳酸堆积及术后WBC。

Objective：To retrospectively analyze the risk factors of delayed recovery after bow replacement extracorporeal circulation operation for patients with Stanford A aortic dissection.Methods：The clinical data of all patients with aortic dissection bow replacement treated with deep hypothemic circulatory arrest（DHCA）and selective anterograde cerebral perfusion（SACP）was analyzed.All patients were divided into normal consciousness group and postoperative delayed awakening group according to the situation of postoperative 24 hours consciousness recovery.Then the independent risk factor of postoperative delayed recovery was analyzed by logistic regression model.Results：The SACP time,intraoperative highest lactic acid value,and Postoperative white blood cell（WBC）count were the independent risk factors of postoperative delayed awakening.Conclusion：Delayed recovery after bow replacement extracorporeal circulation operation for Stanford A aortic dissection is the result of multiple factors.It should shorten the SACP time,reduce the intraoperative lactic acid value and the postoperative WBC count to improve the symptoms.