右半弓手术和全弓手术对急性A型主动脉夹层患者术后神经系统的影响分析

Analysis of the effect of right hemi-arch and total arch replacement operation on postoperative nervous system in patients with acute type A aortic dissection

目的:评价急性A型主动脉夹层采取右半弓手术及全弓置换术后,患者神经系统并发症的影响。方法:回顾性分析我院心胸血管外科,2014年1月至2017年12月之间收治的A型主动脉夹层患者100例,根据手术方式的不同分为全弓置换组(53例)及半弓置换组(47例),记录两组患者术前的一般资料、术中体外循环时间、主动脉阻断时间及选择性脑灌注时间,术后患者出现认知功能障碍及神经系统并发症发生的情况。结果:除了主动脉阻断时间以外,两组患者在术前一般资料、术中情况及术后出现认知功能障碍及神经系统的并发症发生率方面,差异无统计学意义(P>0.05)。结论:对于A型急性主动脉夹层患者,右半弓置换或者全弓置换术复患者术后神经系统影响无差异,应结合患者的综合情况决定患者手术方式。

Objective: To compare the effect of acute type A aortic dissection on neurological complications after right hemi-arch surgery and total arch replacement. Methods: A retrospective analysis of 100 patients with A-type aortic dissection treated between January 2014 and December 2017 in the Department of Cardiothoracic and Cardiovascular Surgery in our hospital was divided into total arch replacement group(53 cases) and right hemi-arch replacement group(47 cases). We recorded the characters of patients and their cardiopulmonary bypass time, aortic clamping time, and selective cerebral perfusion time, postoperative cognitive dysfunction and neurological complications. Results: In addition to aortic clamping time, there was no statistical difference in preoperative general data, intraoperative conditions, postoperative cognitive impairment, and neurological complications(all P>0.05). Conclusions: For patients with type A acute aortic dissection, there is no difference in the effect of postoperative neurological system on patients with right hemi-arch replacement or total arch replacement. The produce should be determined in combination with the patient’s general condition.