Objective:This study analyzed the risk factors of neurological complications in patients with Stanford type A aortic dissection after Sun’s procedure in a single-center with the purpose of improving the effects.Metho...Objective:This study analyzed the risk factors of neurological complications in patients with Stanford type A aortic dissection after Sun’s procedure in a single-center with the purpose of improving the effects.Methods:From January 2019 to December 2020,the clinical data of 480 patients with Stanford type A aortic dissection,who were treated by Sun’s procedure in our center were retrospectively analyzed.Univariate and multivariate logistic regression analyses were used to determine the risk factors of postoperative neurological complications.According to whether there were neurological complications after surgery,they were divided into two groups:the group with complications(n=70)and the group without complications(n=410).The clinical data of the two groups were collected and compared.Results:There were 70 cases of patients with postoperative neurological complications in 480 cases.The incidence rates of temporary neurological dysfunction(TND)and permanent neurological dysfunction(PND)was 11.5%(55/480)and 3.1%(15/480),respectively.Univariate analysis showed that the age(≥70 years),stroke history,femoral artery intubation and cardiopulmonary bypass(CPB)time were associated with postoperative PND(p<0.05).Renal dysfunction,emergency surgery,postoperative hypernatremia,postoperative hyperglycemia,postoperative hypoxemia,postoperative low cardiac output syndrome,and assisted time of suction influenced the occurrence of postoperative TND(p<0.05).Multivariate logistic regression analysis showed that age(≥70 years),stroke history,femoral artery intubation and CPB time were independent risk factors for PND.Renal dysfunction,emergency surgery,postoperative hypernatremia,postoperative hyperglycemia,postoperative hypoxemia,postoperative low cardiac output syndrome,and aspiration time were independent risk factors for TND.Compared with the two groups,the hospitalization time and ICU time of the patients in the neurological complications group were significantly prolonged,and the mortality rate was significantly increased(p<0.05).Conclusion:There are many risk factors for neurological complications in patients with Stanford type A aortic dissection after surgery.With the improvement of surgical techniques,optimization of cerebral perfusion,and interventions for risk factors,Sun’s procedure remains the preferred treatment for Stanford type A aortic dissection.展开更多
目的总结保留自体头臂血管孙氏手术治疗慢性A型主动脉夹层（chronic type A aortic dissection，CTAD）的临床效果和适应证。方法回顾性分析2010年9月至2013年12月23例在我院接受保留自体头臂血管孙氏手术治疗的CTAD患者的临床资料。手...目的总结保留自体头臂血管孙氏手术治疗慢性A型主动脉夹层（chronic type A aortic dissection，CTAD）的临床效果和适应证。方法回顾性分析2010年9月至2013年12月23例在我院接受保留自体头臂血管孙氏手术治疗的CTAD患者的临床资料。手术均在中低温停循环、选择性脑灌注下完成。男20例，女3例，年龄（49．91±10．05）岁。术前合并马方综合征1例，单发左椎动脉1例，高血压19例，冠心病2例，心功能不全、肾功能不全、二尖瓣反流及肺部感染各1例；既往覆膜支架置入术3例，冠状动脉支架置入术1例，主动脉瓣置换术、Bentall术及冠状动脉旁路移植术各1例。结果全组手术时问（6．43±1．03）h，体外循环（167．07±49．62）min，主动脉阻断（80．74±29．00）min，选择性脑灌注（27．35±6．03）min。同期Bentall术6例，升主动脉替换术17例，升主一左股动脉转流术、二尖瓣成形术及冠状动脉旁路移植术各1例。术后早期死亡2例（8．70％）。术后发生一过性肾功能损伤3例，因肾衰竭行透析治疗1例；低氧血症2例，其中1例行二次气管插管。21例康复出院。术后随访（52．52±9．89）个月，失访1例，随访率95．23％。随访期间1例发生脑栓塞，经治后康复。其余患者无并发症。结论对于合适的CTAD患者，应用保留头臂血管孙氏手术简化了弓部手术操作并获得了满意的临床效果，但应严格把握手术适应证。展开更多
文摘Objective:This study analyzed the risk factors of neurological complications in patients with Stanford type A aortic dissection after Sun’s procedure in a single-center with the purpose of improving the effects.Methods:From January 2019 to December 2020,the clinical data of 480 patients with Stanford type A aortic dissection,who were treated by Sun’s procedure in our center were retrospectively analyzed.Univariate and multivariate logistic regression analyses were used to determine the risk factors of postoperative neurological complications.According to whether there were neurological complications after surgery,they were divided into two groups:the group with complications(n=70)and the group without complications(n=410).The clinical data of the two groups were collected and compared.Results:There were 70 cases of patients with postoperative neurological complications in 480 cases.The incidence rates of temporary neurological dysfunction(TND)and permanent neurological dysfunction(PND)was 11.5%(55/480)and 3.1%(15/480),respectively.Univariate analysis showed that the age(≥70 years),stroke history,femoral artery intubation and cardiopulmonary bypass(CPB)time were associated with postoperative PND(p<0.05).Renal dysfunction,emergency surgery,postoperative hypernatremia,postoperative hyperglycemia,postoperative hypoxemia,postoperative low cardiac output syndrome,and assisted time of suction influenced the occurrence of postoperative TND(p<0.05).Multivariate logistic regression analysis showed that age(≥70 years),stroke history,femoral artery intubation and CPB time were independent risk factors for PND.Renal dysfunction,emergency surgery,postoperative hypernatremia,postoperative hyperglycemia,postoperative hypoxemia,postoperative low cardiac output syndrome,and aspiration time were independent risk factors for TND.Compared with the two groups,the hospitalization time and ICU time of the patients in the neurological complications group were significantly prolonged,and the mortality rate was significantly increased(p<0.05).Conclusion:There are many risk factors for neurological complications in patients with Stanford type A aortic dissection after surgery.With the improvement of surgical techniques,optimization of cerebral perfusion,and interventions for risk factors,Sun’s procedure remains the preferred treatment for Stanford type A aortic dissection.
文摘目的总结保留自体头臂血管孙氏手术治疗慢性A型主动脉夹层（chronic type A aortic dissection，CTAD）的临床效果和适应证。方法回顾性分析2010年9月至2013年12月23例在我院接受保留自体头臂血管孙氏手术治疗的CTAD患者的临床资料。手术均在中低温停循环、选择性脑灌注下完成。男20例，女3例，年龄（49．91±10．05）岁。术前合并马方综合征1例，单发左椎动脉1例，高血压19例，冠心病2例，心功能不全、肾功能不全、二尖瓣反流及肺部感染各1例；既往覆膜支架置入术3例，冠状动脉支架置入术1例，主动脉瓣置换术、Bentall术及冠状动脉旁路移植术各1例。结果全组手术时问（6．43±1．03）h，体外循环（167．07±49．62）min，主动脉阻断（80．74±29．00）min，选择性脑灌注（27．35±6．03）min。同期Bentall术6例，升主动脉替换术17例，升主一左股动脉转流术、二尖瓣成形术及冠状动脉旁路移植术各1例。术后早期死亡2例（8．70％）。术后发生一过性肾功能损伤3例，因肾衰竭行透析治疗1例；低氧血症2例，其中1例行二次气管插管。21例康复出院。术后随访（52．52±9．89）个月，失访1例，随访率95．23％。随访期间1例发生脑栓塞，经治后康复。其余患者无并发症。结论对于合适的CTAD患者，应用保留头臂血管孙氏手术简化了弓部手术操作并获得了满意的临床效果，但应严格把握手术适应证。
