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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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1001255309008900719
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不同停循环时间对深低温停循环患者术后的脑保护效应
The postoperative neuroprotective effect of different circulatory arrest time in patients undergoing deep hypothermic circulatory arrest.

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DOI:
作者:
孙晓琼,陆秉玮,陈杰,王维俊,薛松,王祥瑞
SUN Xiaoqiong,，LU Bingwei，Chen Jie，Wang Wei-jun，Xu
作者单位:
上海交通大学医学院附属仁济医院麻醉科
Deportment of Anesthesiology，Renji Hospital，Shanghai Jiaotong University School of Medicine，Shanghai 200127，China.
关键词:
深低温停循环；脑灌注；停循环时间；脑保护；并发症
Deep hypothermic circulatory arrest；cerebral perfusion；CA time; Neuroprotection；Complications
摘要:
[摘要] 目的 观察不同停循环时间对深低温停循环患者术后的脑保护效应。方法 应用DHCA的患者56例，根据术中行脑灌注情况分为：脑灌注组(n=18例，Ⅰ组）和对照组（n=38例,Ⅱ组）。再根据停循环时间（CA时间）将各组分层：CA时间<40min为Ⅰa组(n= 11)和Ⅱa组（n=33），CA时间>40min为Ⅰb组（n= 7）和Ⅱb组（n=5）。记录术前一般资料、术中各项生理参数及术后神经精神症状，观察术后脑保护效应。 结果 脑灌注组的神经精神并发症发生率为11.1％(2/18)，对照组的术后神经精神系统并发症发生率为39.5％(15/38)，I组术后神经精神并发症少于II组(P值<0.05)。Ia组术后神经精神系统并发症发生率与Ib组没有差异（P值>0.05），IIb组术后神经精神系统并发症发生率较IIa组高（P值<0.05），Ib组有7例(38.9％)出现神经精神并发症，低于IIb组（5例，13.2％，P<0.05），Ia组术后神经精神并发症发生率与IIa组无差异（P值>0.05）。结论 脑灌注对行DHCA患者术后脑保护有效，同时停循环时间＜40min对单纯DHCA患者术后脑保护有效。
[Abstract] Objective: To observe the postoperative neuroprotective effect of different circulatory arrest time in patients undergoing deep hypothermic circulatory arrest. Method: 56 patients undergoing DHCA were divided into 2 groups: cerebral perfusion group (group I, n=18) and compare group(group II, n=38). And due to duration of circulatory arrest (CA time), each group was divided into 2 groups: CA Time<40min, group Ia(n=11) and group IIa(n=33), and CA Time>40min, group Ib(n=7) and group IIb(n=5). The general information before operation, physical parameters when undergoing operation and nerve and mental symptom were recorded, and the brain protection effects and safety in perioperative were under observation. Results: Nerve complication rate was 12.5%(7/56) after operation, and mental complication rate was 17.9%(10/56). The complication rates of nerve and mental system were 39.5%(15/38) in group II(hemiplegia 2, amelioration of hyperalgesia 1, MRI showing T3 Ischemia 1, and epilepsy 1), while the complication rate was 11.1%(2/18) in group I, Group I's complication rate of nerve and mental system is lower than group II(P<0.05). Analyzing by divisible group and layer of method of DHCA and duration of CA, rate of nerve and mental symptom was 9% for group Ia(1/11), 14%(1/7) for group Ib, 33%(11/33) for group IIa, and 80%(4/5) for group IIb. Nerve and mental system complication rate of group Ib is lower than that of gourp IIb(P<0.05), while for groups of CA time<40min, there's no difference(P>0.05) between group Ia and group IIa. On the other hand, in group I, there was no difference(P>0.05) in rate of nerve and mental systme complication between group Ia and group Ib, while in group II, the rate in group IIb is higher than group IIa. Conclusion: Cerebral perfusion is effective in neuroprotection of patients undergoing DHCA. Time of circulatory arrest less than 40 min is effective in neurprotection of patients undergoing DHCA without cerebral perfusion.

 

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