中度低温停循环在Stanford A型主动脉夹层手术中的应用研究

Application research of moderate hypothermia circulatory arrest in patients with Stanford A aortic dissection

目的探讨中度低温(28℃)在Stanford A型主动脉夹层手术中的应用研究。方法分析2012年1月至2014年3月收治的100例接受手术治疗的Stanford A型主动脉夹层患者,其中50例应用深度低温(25℃)停循环技术,50例应用中度低温(28℃)停循环技术。手术方式为升主动脉置换术,内覆式主动脉弓部置换术,降主动脉支架人工血管置入术。对比研究两组术中及术后相关指标。结果中度低温组死亡2例,深度低温组死亡3例。中度低温组在降温时间、停循环时间、复温时间、体外循环时间、手术时间、术后清醒时间、机械通气时间、术后第1天转氨酶较深度低温组明显降低(P<0.05),但术后肌酐、总胆红素、卒中、下肢轻瘫等神经系统并发症组间比较无明显差异(P>0.05),一过性意识障碍组间比较有明显差异(P<0.05)。中度低温组在术后神经系统并发症和深度低温组比较无明显差异(P>0.05)。结论在保证充分脑灌注及脊髓保护的条件下,中度低温在Stanford A型主动脉夹层手术治疗中应用较为安全,且能减少手术时间及术后并发症。

Objective To investigate the experience of moderate hypothermia(28℃)using in Stanford A aortic dissection.Methods A retrospective analysis of 100 patients with Stanford A aortic dissection from January 2012 to March 2014,including 50 cases with deep(25℃)hypothermic circulatory surgery and 50 moderate(28℃)hypothermic circulatory surgery.The operation was performed with ascending aortic replacement,inclusiong aortic arch angioplasty,and stent implantation with descending aorta stent.The difference between the 2 groups during and after the operation was compared.Results 2 cases died in the hypothermia group,and 3 cases died in the deep hypothermia group.There were significant differences(P<0.05)between the middle and low temperature groups in the cooling time,the time of stopping circulation,the time of rewarming,the time of cardiopulmonary bypass,the time of operation,the time of operation,the time of conscious,the time of mechanical ventilation and the first day after the operation(P<0.05),but there was no significant difference between the creatinine and the bilirubin(P>0.05).Conclusion Under the condition of sufficient cerebral perfusion and spinal cord protection,moderate hypothermia is safe,and it can reduce the operation time and postoperative complications.It has certain clinical significance.