中-浅低温停循环行主动脉弓部手术后神经系统并发症发生危险因素及与术中最低膀胱温的关系

Risk factors of nervous system complications after aortic arch surgery under shallow-moderate hypothermia circulatiory arrest and their relationship with intraoperative lowest bladder temperature

目的探讨中-浅低温停循环行主动脉弓部手术后神经系统并发症发生危险因素及与术中降温至最低膀胱温的关系,旨在为术中停循环下温度控制及预后改善提供更多参考。方法回顾性纳入2016年1月至2023年1月于本院行中-浅低温停循环主动脉弓部手术患者共123例,根据术后有无神经系统并发症分为并发症组(35例)和无并发症组(88例);采用单因素和Logistic回归模型多因素分析确定患者神经系统并发症发生独立危险因素,并进一步通过多元线性回归模型评估术中最低膀胱温与患者神经系统并发症发生风险间的关系。结果单因素分析结果显示,术前脑灌注情况、术中最低膀胱温、手术时间、体外循环时间及升主动脉阻断时间均可能与主动脉弓部手术患者神经系统并发症发生有关(P<0.05);Logistic回归模型多因素分析结果显示,术前脑灌注不良和术中最低膀胱温均是中-浅低温停循环行主动脉弓部手术患者神经系统并发症发生独立危险因素(OR=1.26,1.85,95%CI:1.12~4.48,1.37~6.83,P<0.05);多元线性回归模型分析结果显示,术中最低膀胱温与患者术后神经系统并发症发生风险独立相关(OR=0.54,95%CI:0.30~0.91,P=0.02);其中术中最低膀胱温30~34℃是患者神经系统并发症发生独立保护因素(OR=0.07,95%CI:0.01~0.92,P=0.04)。结论中-浅低温停循环行主动脉弓部手术患者神经系统并发症发生与术前脑灌注情况和术中最低膀胱温有关,术中维持膀胱温在浅低温有助于降低神经系统并发症发生风险。

Objective To investigate the risk factors of nervous system complications after aortic arch surgery under shallow-moderate hypothermia circulatory arrest and their relationship with intraoperative lowest bladder temperature to provide more reference for temperature control and prognosis improvement during intraoperative circulation arrest.Methods A total of 123 patients who underwent aortic arch surgery under shallow-moderate hypothermia circulatory arrest from January 2016 to January 2023 in our hospital were retrospectively selected.Based on the occurrence of postoperative neurological complications,the patients were divided into two groups:complication group(35 cases)and non-complication group(88 cases).Univariate and logistic regression models were used to identify independent risk factors for neurological complications,and multiple linear regression models were used to evaluate the relationship between intraoperative lowest bladder temperature and the risk of neurological complications.Results Univariate analysis showed that preoperative cerebral perfusion,intraoperative lowest bladder temperature,operative time,cardiopulmonary bypass time and ascending aorta occlusion time might be related to the occurrence of neurological complications in patients undergoing aortic arch surgery(P<0.05).Multivariate analysis using logistic regression model showed that preoperative poor cerebral perfusion and intraoperative lowest bladder temperature were independent risk factors for neurological complications in patients undergoing aortic arch surgery(OR=1.26,1.85,95%CI:1.12~4.48,1.37~6.83,P<0.05).Multiple linear regression model analysis showed that intraoperative lowest bladder temperature was independently associated with the risk of postoperative neurological complications(OR=0.54,95%CI:0.30~0.91,P=0.02).Intraoperative lowest bladder temperature of 30~34℃was the independent protective factor for neurological complications(OR=0.07,95%CI:0.01~0.92,P=0.04).Conclusion The incidence of neurological complications in patients undergoing shallow-moderate hypothermia circulatory arrest aortic arch surgery was related to preoperative cerebral perfusion and intraoperative lowest bladder temperature.Intraoperative hypothermia of the bladder may be helpful to reduce the risk of neurological complications.