单侧和双侧选择性顺行脑灌注对DeBakey Ⅰ型主动脉夹层患者的脑保护作用及对认知功能的影响

The brain protective effect of unilateral and bilateral selective antegrade cerebral perfusion in patients with DeBakey typeⅠaortic dissection and their effect on cognitive function of the patients

目的探讨单侧和双侧选择性顺行脑灌注(ASCP)对DeBakeyⅠ型主动脉夹层患者的脑保护作用及对认知功能的影响。方法我院收治的83例DeBakeyⅠ型主动脉夹层患者,分为单侧ASCP组(n=42)和双侧ASCP组(n=41),比较两组体外循环时间、主动脉阻断时间、脑灌注时间、机械通气时间、术后清醒时间、重症监护病房停留时间、住院时间及胸腔积液、肺部感染、二次开胸、急性肾衰竭、院内死亡、神经功能障碍发生率和认知功能(MMSE)评分。结果两组体外循环时间、主动脉阻断时间、脑灌注时间、住院时间及胸腔积液、肺部感染、二次开胸、急性肾衰竭和院内死亡发生率比较差异无统计学意义(P>0.05),双侧ASCP组机械通气时间、术后清醒时间、重症监护病房停留时间短于单侧ASCP组,暂时性神经功能障碍发生率低于单侧ASCP组(P<0.05);术后6个月两组MMSE评分比较差异无统计学意义(P>0.05)。结论单侧ASCP和双侧ASCP对DeBakeyⅠ型主动脉夹层患者认知功能的无明显影响,但后者对脑保护疗效更佳。

Objective To investigate the brain protective effects of unilateral antegrade selective cerebral perfusion(ASCP)and bilateral ASCP in patients with DeBakey typeⅠaortic dissection and their influence on cognitive function.Methods The clinical data of 83 patients with DeBakey type I aortic dissection admitted and treated in our hospital were retrospectively analyzed.The patients were divided into unilateral ASCP group(n=42)and bilateral ASCP group(n=41).The cardiopulmonary bypass time,aortic occlusion time,cerebral perfusion time,mechanical ventilation time,postoperative awake time,length of intensive care unit stay,hospital stay,incidences of pleural effusion,lung infection,secondary thoracotomy,acute renal failure,nosocomial death and neurological dysfunction as well as cognitive function(MMSE)scores were compared between the two groups.Results There was no significant difference in cardiopulmonary bypass time,aortic occlusion time,cerebral perfusion time,hospital stay or incidences of pleural effusion,lung infection,secondary thoracotomy,acute renal failure and nosocomial death between the two groups(P>0.05).The mechanical ventilation time,postoperative awake time and length of intensive care unit stay of the bilateral ASCP group were shorter than those of the unilateral ASCP group,and the incidence of temporary neurological dysfunction was lower than that in the unilateral ASCP group(P<0.05).There was no significant difference in MMSE score between the two groups after 6 months of operation(P>0.05).Conclusion Unilateral ASCP and bilateral ASCP have no significant effect on the cognitive function of patients with DeBakey typeⅠaortic dissection,but the latter has a better protective effect on brain.