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发行周期:
月刊
主管单位:
上海市卫生健康委员会
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上海市医学会
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CN31-1366/R
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不同复温比值对深低温停循环患者术后的脑保护效应
The postoperative neuroprotective effect of different ratios of circulatory arrest time to rewarming time in patients undergoing deep hypothermic circulatory arrest.

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DOI:
作者:
陆秉玮,孙晓琼,陈杰,王维俊,薛松,王祥瑞
LU Bingwei，SUN Xiaoqiong，Chen Jie，et al.
作者单位:
上海交通大学医学院附属仁济医院 麻醉科（陆秉玮，孙晓琼，陈杰，王祥瑞） 上海交通大学医学院附属仁济医院 心胸外科（王维俊，薛松）
Deportment of Anesthesiology，Renji Hospital，Shanghai Jiaotong University School of Medicine，Shanghai 200127，China. Department of Cardiothoracic Surgery，Renji Hospital，Shanghai Jiaotong University School of Medicine，Shanghai 200127，China.
关键词:
深低温停循环；复温比值；脑保护；并发症
Deep hypothermic circulatory arrest；Rewarming time ratio； Neuroprotection； Complications
摘要:
[摘要] 目的 观察不同停循环时间与复温时间比值对深低温停循环（DHCA）患者术后脑保护的有效性。方法 行DHCA的患者57例，根据术中行脑灌注情况，分为行选择性脑灌注组（Ⅰ组，n=20）与单纯DHCA组（Ⅱ组，n=37），各组患者再根据停循环时间与复温时间的比值分层，比值在0.1 ～ 0.5（包括0.5）为ⅠA组(n= 13)和ⅡA组（n=29），比值在0.5 ～ 0.7（包括0.7）为ⅠB组（n= 7 ）和ⅡB组（n=6），2例比值为0.9的另做讨论。记录ⅠA，ⅠB，ⅡA，ⅡB组的体外循环（CPB）时间，辅助循环时间，最低鼻咽温，最低肛温。测定麻醉后行CPB前，CPB开始后DHCA开始前，DHCA结束恢复CPB后5~10min，以及停止CPB后的平均动脉压，血红蛋白压积，鼻咽温，肛温。记录各组的术后神经精神并发症的发生情况。 结果 57例患者术后出现神经并发症的发生率为10.5%（6 / 57）,发生精神并发症发生率为19.3 %（11 / 57）。行Ⅰ组患者神经精神并发症发生率为10.0 % （2 / 20），Ⅱ组患者神经精神发生率为40.5 % （15 / 37），行分层后发现ⅠA组神经精神并发症发生率为15.4 %（2 /13），ⅠB组为0，ⅡA组为27.6%（8/29），ⅡB组为83.3%（5/6），ⅡA与ⅡB组并发症发生率差异有统计学意义（P＜0.05）。结论 复温比值在0.1~ 0.5对单纯行DHCA患者术后脑保护有效。
[Abstract] Objective To observe the postoperative neuroprotective effect of different ratios of circulatory arrest time to rewarming time in patients undergoing deep hypothermic circulatory arrest (DHCA). Methods Fifty-seven patients undergoing DHCA were divided into two groups: DHCA combined with selective cerebral perfusion group (group Ⅰ,n=20), DHCA group (group Ⅱ,n= 37). Each group was divided into two subgroups: the ratio of circulatory arrest Time to temperature rewarming time between 0.1 ~ 0.5 (including 0.5) groups ( groupⅠA, n= 13 groupⅡA, n= 29), the ratio between 0.5 ~ 0.7 (including 0.7) groups (groupⅠB, n= 7 group ⅡB,n=6). The other two ratios which are more than 0.9 would be discussed separately. The cardiopulmonary bypass（CPB）time，the assisted circulation time, the lowest nasopharynx and rectal temperature were measured. MAP, Hct, nasopharynx temperatures and rectal temperatures were measured four times: after anesthetic induction before CPB (T0), after CPB before DHCA (T1), 5 ~ 10 min after restarting CPB (T2) and the end of CPB (T3). The complications of nerve and psyche were recorded. Results The complication ratio of nerve was 10.5% and the complication ratio of psyche was 19.3 %. The complication ratio of nerve and psyche was 10.0% in group Ⅰ，which was lower than 40.5% in group Ⅱ（P＜0.05）. The ratio was 15.4% in group ⅠA，0 in group ⅠB, 27.6% in group ⅡA, 83.3% in group ⅡB. The ratio of group ⅡA was lower than which of group ⅡB (P＜0.05). Conclusion The ratio of circulatory arrest time to rewarming time between 0.1~0.5 is effective for the postoperative neuroprotection in patients undergoing deep hypothermic circulatory arrest.

 

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