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

doi:10.3969/j.issn.1006-7795.2015.03.006

Abstract

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

CLC Number:

R543.1

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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URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2015.03.006

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2015/V36/I3/364

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