术前CTA预测急性A型主动脉夹层术后脑并发症的危险因素

Analysis of CTA Risk Factors of Postoperative Neurological Complications of Acute Stanford Type A Aortic Dissection

目的研究急性Standford A型主动脉夹层术后脑神经系统并发症(Neurological Dysfunction,ND)的CTA征象的危险因素。方法回顾2014年1月至2016年6月255例经急诊外科手术治疗的急性Standford A型主动脉夹层患者的临床及影像资料。对术后脑神经系统并发症:永久性神经系统功能不全(Permanent Neurological Dysfunction,PND)及短暂性神经系统功能不全(Temporary Neurological Dysfunction,TND)的影响因素分别进行单因素分析,将单因素分析中具有统计学差异的变量进行logistic回归多因素分析。影响因素包括临床基线资料、术中资料,及术前CTA影像特征。结果 255例患者中出现术后脑神经系统并发症共56例(21.96%),其中PND 18例(7.06%),TND 38例(14.90%)。Logistic回归多因素分析显示:主动脉弓部破口(OR=21.325,P=0.008)、颈总动脉撕裂(OR=14.441,P=0.022)及一侧颈内动脉密度减低(OR=9.141,P=0.024)是术后TND的危险因素;主动脉逆行撕裂(OR=5.622,P=0.003)、主动脉弓部破口(OR=6.742,P=0.006)是术后PND的危险因素。结论主动脉弓部破口、颈总动脉撕裂及一侧颈内动脉密度减低,是术后TND独立危险因素;而弓部破口及主动脉逆行撕裂是PND独立危险因素。术前CTA提供的高风险征象是早期预防、干预脑神经系统并发症发生的有利证据。

Objective To analyze risk factors for cerebral neurological injury after operation of acute Stanford type A aortic dissection to CTA morphological study. Methods From January 2015 to June 2016, 110 cases of acute Stanford type A aortic dissection patients underwent aortic arch replacement were retrospectively analyzed. Univariate and multivariate analysis(multiple logistic regression) were used to identify the risk factors for postoperative cerebral neurological injury including permanent neurological dysfunction(PND) and temporary neurological dysfunction(TND). Results Cerebral neurological injury occurred in 18 cases(18%), PND 4 cases(4%) and TND 14 cases(14%). Preoperative imaging features of CTA of 18 patients with postoperative ND: arotic arch intimal tear 17 cases(94.4%), common carotid artery dissection 15 cases(83.3%) dissection involving right ICA 13 cases(72.2%), and low attenuation in unilateral ICA 8 cases(44.4%). Multiple logistic regression showed that arotic arch intimal tear(OR=21.325, P=0.008), common carotid artery dissection(OR=14.441, P=0.022) and low attenuation in unilateral ICA(OR=9.141, P=0.024) were independent risk factors for ND. Conclusion Preoperative CTA image characteristics(arotic arch intimal tear, common carotid artery dissection, low attenuation in unilateral ICA) indicate the occurrence of ND. These signs can indicate intracranial ischemia, provide clinical evidence for early intervention to reduce the happening of the ND.