CAJ | 학술논문

目的：探讨深低温停循环（ DHCA）下主动脉手术后发生中枢神经系统（ CNS）并发症的危险因素。方法2009年1月至2013年10月对70例主动脉夹层及主动脉瘤患者在DHCA下行手术治疗，根据术后有无CNS并发症分为并发症组（26例）和对照组（44例）。采用单因素和多因素Logistic回归分析危险因素。结果术后CNS并发症26例（37.14％），其中短暂性神经功能障碍18例，永久性神经功能障碍7例，截瘫1例；死亡1例。术前合并高血压（ P ＝0.001）、发病72 h内急症手术（ P ＝0.009）、体外循环时间（ P ＝0.015）、术中脑灌注流量（ P ＝0.005）、术中血液稀释度（ P ＝0.001）、术中及术后24 h内红细胞（ P ＝0.033）及血浆输注总量（ P ＝0.034）、术后4 h内氧合指数＜200 mmHg（ P ＝0.043）、术后24 h血压波动＞80 mmHg（ P ＝0.037）、术后24 h内血钠峰值（ P ＝0.001）、急性生理与慢性健康评分-II（APACHE II）评分（ P ＝0.008）为术后CNS损伤的危险因素。术前高血压病史（ P ＝0.017）、发病后72 h内急症手术（ P ＝0.048）、术中脑灌注流量（ P ＝0.015）、术后24 h血钠＞150 mmol/L（ P ＝0.008）是术后CNS损伤的独立危险因素。结论术前充分评估病情，加强血压控制，术中选择合适的脑灌注方法和流量，合理控制血液稀释度，术后加强电解质监测及高钠血症及时防治，可望减少DHCA主动脉手术后CNS并发症的发生。
목적：탐토심저온정순배（ DHCA）하주동맥수술후발생중추신경계통（ CNS）병발증적위험인소。방법2009년1월지2013년10월대70례주동맥협층급주동맥류환자재DHCA하행수술치료，근거술후유무CNS병발증분위병발증조（26례）화대조조（44례）。채용단인소화다인소Logistic회귀분석위험인소。결과술후CNS병발증26례（37.14％），기중단잠성신경공능장애18례，영구성신경공능장애7례，절탄1례；사망1례。술전합병고혈압（ P ＝0.001）、발병72 h내급증수술（ P ＝0.009）、체외순배시간（ P ＝0.015）、술중뇌관주류량（ P ＝0.005）、술중혈액희석도（ P ＝0.001）、술중급술후24 h내홍세포（ P ＝0.033）급혈장수주총량（ P ＝0.034）、술후4 h내양합지수＜200 mmHg（ P ＝0.043）、술후24 h혈압파동＞80 mmHg（ P ＝0.037）、술후24 h내혈납봉치（ P ＝0.001）、급성생리여만성건강평분-II（APACHE II）평분（ P ＝0.008）위술후CNS손상적위험인소。술전고혈압병사（ P ＝0.017）、발병후72 h내급증수술（ P ＝0.048）、술중뇌관주류량（ P ＝0.015）、술후24 h혈납＞150 mmol/L（ P ＝0.008）시술후CNS손상적독립위험인소。결론술전충분평고병정，가강혈압공제，술중선택합괄적뇌관주방법화류량，합리공제혈액희석도，술후가강전해질감측급고납혈증급시방치，가망감소DHCA주동맥수술후CNS병발증적발생。
Objective To investigate the risk factors for neurological complications after deep hypothermic ciculatory arrest (DHCA) operation.Methods From January 2009 to October 2013, 70 patients who were diagnosed as aortic dissection or aortic an-eurysm underwent aortic operations under DHCA .According to the occurrence of neurological complications after surgery , patients were divided into neurological complication group (26 patients) and normal group (44 patients).Risk factors of neurological complications after surgery were evaluated by univariate analysis and multivariate logistic regression analysis .Results Central neurological compli-cations occurred in 26 patients (37.14%) , including 18 patients with temporary neurological dysfunction and 7 patients with perma-nent neurological dysfunction , 1 patient with paraplegia , 1 patient died of cerebral infarction .Univariate analysis showed that hyperten-sion disease( P =0.001), emergency surgery within 72 hours( P =0.009),cardiopulmonary bypass time ( P =0.015),antegrade se-lective cerebral perfusion ( ASCP) ( P =0.005 ) , hemodilution degree ( P =0.001 ) , erythrocyte ( P =0.033 ) and plasma ( P =0.034 ) transfusion volume in the perioperative period , oxygen index <200 mmHg in 4 hours postoperatively ( P =0.043 ) , arterial blood pressure instability ( P =0.037 ) and hypernatremia in 24 hours postoperatively ( P =0.001 ) , and the Acute Physiology And Chronic Health Evaluation II (APACHE II) score are the risk factors for central neurological complication .Hypertension disease( P =0.017 ) , emergency surgery within 72 hours ( P =0.048 ) , ASCP ( P =0.015 ) , hypernatremia in 24 hours postoperatively ( P =0.008 ) were independent determinats for central neurological complication .Conclusions A series of procedure including evaluating patients condition correctly before operation , controlling hypertension effectively in the perioperative period , applying the ASCP and the suitable hemodilution degree in operation , maintaining electrolyte balance , and correcting hypernatremia timely in the postoperative pe-riod maybe reduce the incidence of neurological complications after DHCA operation .