急性Stanford A型主动脉夹层患者主动脉弓部手术后脑部并发症发病情况及危险因素分析

Risk factors for cerebral neurological injury after operation for acute Stanford type A aortic arch dissection

摘要:

目的  回顾性分析急性Stanford A型主动脉夹层患者主动脉弓部手术后脑部并发症发病情况，并对其危险因素进行分析，为术后脑部并发症临床监测及干预提供依据。方法  回顾性分析2006年1月-2012年12月该院收治的388例急性Stanford A型主动脉夹层行主动脉弓部手术患者的临床资料，对术后发生脑神经系统并发症的相关因素进行单因素及多因素Logistic回归分析。结果  388例患者术后发生脑神经系统并发症93例，其中短暂性神经系统功能不全（TND）80例（20.62%），永久性神经系统功能不全（PND）13例（3.35%）。多因素Logistic回归分析结果显示，TND发生的独立危险因素有术前白细胞水平较高、术前血肌酐水平较高、术中主动脉阻断时间较长、术中峰值血糖水平较高，差异有统计学意义（■=1.972、1.846、1.825和2.089，P <0.05）。PND发生的独立性危险因素有年龄、脑卒中史（■=1.756和2.848）。结论  急性Stanford A型主动脉夹层行主动脉弓部手术后发生TND与术前白细胞、肌酐、术中主动脉阻断时间及血糖水平等密切相关，PND的发生与患者年龄和脑卒中史有关，术前抗感染治疗、降低血肌酐及术中积极控制血糖可减少脑部并发症的发生。

Abstract:

Objective To research the risk factors for cerebral neurological injury after operation for acute Stanford type A aortic arch dissection and to supply the intervention for postoperative brain complications. Methods The clinical data of 388 patients with acute Stanford type A aortic dissection who had aortic arch surgery from January 2006 to December 2012 were retrospectively analyzed. And the related factors of brain nerve system complications were analyzed by multi-factor logistic regression. Results There were 93 cases of patients with postoperative complications in the 388 cases, with transient neurological dysfunction (TND) in 80 cases (20.62%) and permanent neurological dysfunction (PND) in 13 cases (3.35%). Multivariable logistic regression analysis showed that the independent risk factors were higher preoperative leucocyte level, higher preoperative serum creatinine level, longer intraoperative aortic block time and higher intraoperative blood glucose level for TND with significant differences (■ =1.972, 1.846, 1.825 and 2.089, P < 0.05); the independent risk factors for PND were age and history of stroke (■ =1.756 and 2.848). Conclusions The occurrence of TND after aortic arch surgery for acute Stanford type A aortic dissection is associated with preoperative white blood cell, creatinine, intraoperative aortic blocking time and blood glucose level. The occurrence of PND is associated with age and the history of stroke. Preoperative anti-infection treatment, reducing serum creatinine and control of intraoperative blood glucose can reduce the rate of brain complications.