低温停循环在Stanford A型主动脉夹层手术中的应用

Application of hypothermic circulatory arrest in operation for Stanford A aortic dissection

目的:探究中低温和深低温停循环麻醉在Stanford A型主动脉夹层(AD)手术中的应用,分析两种麻醉方法对患者手术指标及术后恢复情况的影响。方法:选取2016年5月至2020年5月,收治的Stanford A型AD患者86例,根据麻醉方式将患者分为中低温组(鼻咽温24~28℃,肛温25~28℃,n=47)和深低温组(鼻咽温20~24℃,肛温20~25℃,n=39)。比较两组患者的手术指标、术后恢复情况、术后肺功能、脑损伤及并发症。结果:中低温组的手术时间、降温时间、CPB时间、复温时间、术后带管时间和ICU入住时间均短于深低温组(P<0.05);术后,中低温组的OI、FVC和FEV1水平高于深低温组,RI低于深低温组(P<0.05);术后,中低温组的血清NSE和S-100β水平均小于深低温组(P<0.05);中低温组患者的眼球结膜水肿、脑梗死、短暂性神经功能障碍发生率均小于深低温组(P<0.05)。结论:中低温停循环麻醉在Stanford A型AD手术中具有良好的应用价值,可明显改善患者的预后,减轻手术对肺功能和脑组织的损伤,降低术后并发症发生率,有益于患者恢复。

Objective:To explore the application of anesthesia with moderate and deep hypothermic circulatory arrest in operation for Stanford A aortic dissection(AD)and analyze effects of the two anesthesia method on operation indexes and postoperative recovery.Methods:From May 2016 to May 2020,86 patients with Stanford A AD were enrolled in this study.According to the anesthesia method,they were divided into moderate hypothermia group(nasopharyngeal temperature at 24-28°C,anal temperature at 25-28℃,n=47)and deep hypothermia group(nasopharyngeal temperature at 20-24℃,anal temperature at 20-25℃,n=39).Operation indexes,postoperative recovery,postoperative lung function,brain injury and complications in the 2 groups were compared.Results:The operation time,cooling time,CPB time,rewarming time,postoper-ative carrying catheter time and ICU stay of moderate hypothermia group were shorter than those of the deep hy-pothermia group(P<0.05).After operation,OI,FVC and FEV1 of the moderate hypothermia group were higher than those of the deep hypothermia group,and RI was lower than the deep hypothermia group(P<0.05).After operation,serum NSE and S-100βlevels were lower in the moderate hypothermia group than in the deep hypothermia group(P<0.05).Incidences of chemosis,cerebral infarction,and transient neurological dysfunction were lower in the moderate hypothermia group than in the deep hypothermia group(P<0.05).Con-clusions:Anesthesia with moderate hypothermia circulatory arrest has good application value in operation of Stanford A AD,which can significantly improve operation indexes,reduce the damage to lung function and brain tissues during surgery,lower the incidence of postoperative complications,and promote recovery.