温度梯度分级对Stanford A型主动脉夹层围术期脑保护的影响

doi:10.3969/j.issn.1006-7795.2015.03.006

首都医科大学学报 ›› 2015, Vol. 36 ›› Issue (3): 364-370.doi: 10.3969/j.issn.1006-7795.2015.03.006

• 心脏大血管外科领域前沿进展 • 上一篇下一篇

温度梯度分级对Stanford A型主动脉夹层围术期脑保护的影响

彭小乐^1,2, 王晓龙¹, 刘愚勇¹, 贡鸣¹, 李海洋¹, 关欣亮¹, 郭东¹, 黄琦¹, 张宏家¹

1. 首都医科大学附属北京安贞医院心脏外科北京市心肺血管疾病研究所教育部心血管重塑相关疾病重点实验室北京大血管疾病诊疗中心北京市大血管外科植入式人工材料工程技术研究中心, 北京 100029;
2. 北京市平谷区医院心外科, 北京 101200

收稿日期:2015-03-18 出版日期:2015-06-21 发布日期:2015-06-15
通讯作者: 张宏家 E-mail:zhanghongjia722@hotmail.com
基金资助:
北京市科学技术委员会基金(Z141100002114025).

Effects of temperature gradient classification on perioperative cerebral protection in Stanford A aortic dissection

Peng Xiaole^1,2, Wang Xiaolong¹, Liu Yuyong¹, Gong Ming¹, Li Haiyang¹, Guan Xinliang¹, Guo Dong¹, Huang Qi¹, Zhang Hongjia¹

1. Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, The Key Laboratory of Remodeling-related Cardiovascular Disease, Ministry of Education, Beijing Aortic Disease Center, Cardiovascular Surgery Center, Beijing Engineering Research Center for Vascular Prostheses, Beijing 100029, China;
2. Department of Cardiac Surgery, Beijing Pinggu Hospital, Beijing 101200, China

Received:2015-03-18 Online:2015-06-21 Published:2015-06-15
Supported by:
This study was supported by Beijing Municipal Science & Technology Commission (Z141100002114025).

摘要/Abstract

摘要：

目的通过分析不同的停循环温度对Stanford A型主动脉夹层围术期脑保护的影响,尤其是对术后认知功能的影响,找到最佳的停循环温度,同时找出影响术后认知功能的危险因素,为临床工作提供理论依据.方法纳入Stanford A型主动脉夹层患者66例,低温停循环下行Sun's手术.依据术中停循环期间鼻咽温度分3组(Ⅰ组:18~20 ℃,Ⅱ组:20.1~23 ℃,Ⅲ组23.1~25 ℃).测定患者术前、停循环期间、复温至36 ℃时、术后4 h、术后24 h的神经元特异性烯醇化酶(neuron-specific enolase,NSE)和S-100蛋白含量;术前和术后第7天评估认知功能.结果 3组间神经元特异性烯醇化酶(NSE)与S-100蛋白含量、术后认知功能障碍(post operative cognitive dysfunction,POCD)发生率、术后常见神经系统合并症比较,差异无统计学意义 (P >0.05).通过Logistic分析,体外循环时间是术后认知功能障碍的独立危险因素(P <0.05).结论低流量顺行性脑灌注下行主动脉弓部手术,18~25 ℃停循环温度范围内,温度差异对患者脑损伤程度无显著影响.影响术后认知功能的危险因素较多,体外循环时间在本研究中构成独立危险因素.

关键词: 主动脉夹层, 低温停循环, 脑保护

Abstract:

Objective Perioperative brain damage is the common complication of the aortic operation undergoing hypothermic circulatory arrest, and has no important influence on recovery after operation and long-term quality of life. This study evaluates whether temperature-control induces the cerebral protection in hypothermic circulatory arrest. Methods We enrolled 66 patients who suffered from Stanford A type aortic dissection and underwent aortic arch replacement with stented elephant trunk. The concentration of serum neuron specific enolase (NSE) and S-100 protein was measured before operation, during circulatory arrest, rewarming to 36 ℃, 4 hr and 24 hr postoperation. The nerve function and cognitive function was assessed before surgery and 7 days after operation according to Chinese nervous Function Severity Score (CSS) and Mini-Mental Status Examination (MMSE). Patients were divided into three groups on the basis of nasopharyngeal temperature during circulatory arrest (group Ⅰ: 18-20 ℃, II:20.1-23 ℃, Ⅲ:20.1-23 ℃). The data were analyzed by the software SPSS 19.0. Results There were no significant differences in the gender, age, weight, lesion location, preoperative cardiac function, aortic root and ascending aorta diameter among the three groups. No significant difference was observed in the operation method, circulatory arrest time, cross clamping time, CPB time and operation time between the three groups. There was no significant difference in the CSS score, MMSE score, serum NSE concentration, S-100 protein concentration in patients among three groups before operation. In three groups, there was no significant difference in the postoperative CSS score and MMSE score. The concentration of serum NSE and S-100 protein was not significant different at each time point preoperatively or postoperatively. The logistic analysis showed that cardiopulmonary bypass time was an independent risk factors for postoperative cognitive dysfunction. ConclusionThe temperature difference has no effect on the degree of brain injury when we controlled the temperature of circulatory arrest at 18 ℃-25 ℃ and maintain the brain oxygen supply by antegrade selective cerebral perfusion. The use of cardiopulmonary bypass was the major contributor to post operative cognitive dysfunction(POCD). Involving the aortic arch operation, it is feasible and safe in the theory to increase the circulatory arrest temperature to 25 ℃.

Key words: aortic dissection, hypothermic circulatory arrest, cerebral protection

中图分类号:

R543.1

彭小乐, 王晓龙, 刘愚勇, 贡鸣, 李海洋, 关欣亮, 郭东, 黄琦, 张宏家. 温度梯度分级对Stanford A型主动脉夹层围术期脑保护的影响[J]. 首都医科大学学报, 2015, 36(3): 364-370.

Peng Xiaole, Wang Xiaolong, Liu Yuyong, Gong Ming, Li Haiyang, Guan Xinliang, Guo Dong, Huang Qi, Zhang Hongjia. Effects of temperature gradient classification on perioperative cerebral protection in Stanford A aortic dissection[J]. Journal of Capital Medical University, 2015, 36(3): 364-370.

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温度梯度分级对Stanford A型主动脉夹层围术期脑保护的影响

Effects of temperature gradient classification on perioperative cerebral protection in Stanford A aortic dissection

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