亚低温治疗对急性Stanford A型主动脉夹层患者围术期炎症反应及预后影响的随机对照试验

Therapeutic effect of mild hypothermia on the inflammatory response and outcome in perioperative patients with acute Stanford type A aortic dissection: A randomized controlled trial

目的探讨亚低温治疗对急性Stanford A型主动脉夹层患者围术期炎症反应、器官功能及预后的影响。方法纳入2017年2月至2018年2月我科急性Stanford A型主动脉夹层患者56例,随机分为对照组及试验组,每组各28例。对照组:男20例、女8例,年龄(51.5±8.7)岁;患者在术中经历深低温停循环后,将体温复温至36～37℃,并延续至术后24 h。试验组,男24例、女4例,年龄(53.3±11.2)岁;患者体温复温至34～35℃,余同对照组;比较两组患者预后。结果两组患者临床资料差异无统计学意义。与对照组相比,在术后第24 h,试验组外周血基质金属蛋白酶(MMPs)水平更低(P=0.008)。试验组患者术后苏醒时间更短(P=0.008),血流感染的发生率更低(P=0.019),但两组患者的谵妄发生率、急性肾损伤(AKI)发生率、肝功能不全发生率、机械通气时间、住ICU时间及病死率差异均无统计学意义。两组患者术后24 h内的胸腔引流量差异均无统计学意义,且均未发生寒战。结论亚低温治疗能够缩短急性Stanford A型主动脉夹层患者术后的苏醒时间,降低血流感染的发生率,且不会引起胸腔引流量增多或寒战。

Objective To explore the therapeutic effect of mild hypothermia on the inflammatory response,organ function and outcome in perioperative patients with acute Stanford type A aortic dissection(AAAD).Methods From February 2017 to February 2018,56 patients with AAAD admitted in our department were enrolled and randomly allocated into two groups including a control group and an experimental group.After deep hypothermia circulatory arrest during operation,in the control group(n=28),the patients were rewarmed to normal body temperatures(36 to 37 centigrade degree),and which would be maintained for 24 hours after operation.While in the experimental group(n=28),the patients were rewarmed to mild hypothermia(34 to 35 centigrade degree),and the rest steps were the same to the control group.The thoracic drainage volume and the incidence of shivering at the first 24 hours after operation,inflammatory indicators and organ function during perioperation,and outcomes were compared between the two groups.There were 20 males and 8 females at age of 51.5±8.7 years in the control group,24 males and 4 females at age of 53.3±11.2 years in the experimental group.Results There was no obvious difference in the basic information and operation information in patients between the two groups.Compared to the control group,at the 24 th hour after operation,the level of peripheral blood matrix metalloproteinases(MMPs)was lower than that in the experimental group(P=0.008).In the experimental group,after operation,the awakening time was much shorter(P=0.008),the incidence of bloodstream infection was much lower(P=0.019).While the incidence of delirium,acute kidney injury(AKI),hepatic insufficiency,mechanical ventilation duration,intensive care unit(ICU)stays,or hospital mortality rate showed no statistical difference.And at the first 24 hours after operation,there was no difference in the thoracic drainage volume between the two groups,and no patient suffered from shivering.Conclusion The mild hypothermia therapy is able to shorten the awakening time and reduce the incidence of bloodstream infection after operation in the patients with AAAD,and does not cause the increase of thoracic drainage volume or shivering.