本文選題：Stanford　切入點(diǎn)：A型主動(dòng)脈夾層　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 對(duì)急性Stanford A型主動(dòng)脈夾層患者行孫氏手術(shù)后出現(xiàn)腦神經(jīng)系統(tǒng)并發(fā)癥的相關(guān)危險(xiǎn)因素進(jìn)行分析。方法選取大連市中心醫(yī)院心外科2010年6月-2017年1月82例急性Stanford A型主動(dòng)脈夾層的患者,82例患者均在深低溫停循環(huán)結(jié)合選擇性順行腦灌注下行孫氏手術(shù)(升主動(dòng)脈置換+主動(dòng)脈弓置換+支架象鼻).其中鼻咽溫降至25℃時(shí),開始停循環(huán),同時(shí)經(jīng)右側(cè)腋動(dòng)脈行順行性選擇性腦灌注,流量保持在5-10ml/(kg·min),維持灌注壓40-60mmHg。當(dāng)復(fù)溫至鼻咽溫36.6℃-37.0℃、肛溫34～35℃時(shí),血流動(dòng)力學(xué)平穩(wěn),停止體外循環(huán)。統(tǒng)計(jì)并分析的信息包括年齡、性別、體重、吸煙情況、糖尿病病史、高血壓病史、腦卒中病史、術(shù)前白細(xì)胞水平、術(shù)前神經(jīng)系統(tǒng)癥狀,腎功能肌酐數(shù)值、發(fā)病至手術(shù)間隔時(shí)間、總手術(shù)時(shí)間、體外循環(huán)時(shí)間、主動(dòng)脈阻斷時(shí)間、深低溫停循環(huán)的時(shí)間、最低混合血氧飽和度、復(fù)溫時(shí)間、術(shù)中峰值血糖、術(shù)中輸血量等相關(guān)危險(xiǎn)因素,對(duì)術(shù)后有腦神經(jīng)系統(tǒng)功能并發(fā)癥(永久性神經(jīng)系統(tǒng)功能不全及短暫性神經(jīng)系統(tǒng)功能不全)的相關(guān)影響因素行單因素分析,有統(tǒng)計(jì)學(xué)差異的單因素進(jìn)一步行回歸分析。結(jié)果術(shù)后發(fā)生腦神經(jīng)系統(tǒng)功能不全共15例(18.3%),其中3例患者發(fā)生永久性神經(jīng)系統(tǒng)功能不全(PND)(3.7%),12例患者發(fā)生短暫性神經(jīng)系統(tǒng)功能不全(TND)(14.6%)。單因素分析見:年齡、糖尿病病史、術(shù)前腦神經(jīng)癥狀、血肌酐水平、腦卒中史、術(shù)前白細(xì)胞水平、體外循環(huán)時(shí)間、主動(dòng)脈阻斷時(shí)間,深低溫停循環(huán)的時(shí)間、術(shù)中峰值血糖和術(shù)中輸血量是術(shù)后TND的相關(guān)危險(xiǎn)因素(P0.1);年齡、腦卒中史、主動(dòng)脈阻斷時(shí)間、復(fù)溫時(shí)間是PND的相關(guān)危險(xiǎn)因素(P0.1)。Logistic回歸多因素分析顯示,PND的獨(dú)立危險(xiǎn)因素為年齡(C∧R=1.715,95%C 11.048-3.024,P = 0.027)和卒中史(C∧R=2.657,95%CI 0.943-3.142,P =0.001)。TND發(fā)生的獨(dú)立危險(xiǎn)因素為術(shù)前血肌酐(C∧R =1.956,95%CⅠ 1.237-2.768,P=0.022)、術(shù)前白細(xì)胞數(shù)(WBC)(C∧R=1.587,95%CⅠ 0.764～3.411,P=0.013)和術(shù)中峰值血糖(C∧R= 2.108,9 5%C11.328-3.534,P = 0.007)。結(jié)論通過對(duì)可能與急性Stanford A型主動(dòng)脈夾層手術(shù)后腦神經(jīng)系統(tǒng)并發(fā)癥相關(guān)因素的回歸分析,得出:1.與術(shù)后TND相關(guān)的危險(xiǎn)因素包括:年齡、糖尿病史、術(shù)前腦神經(jīng)癥狀、術(shù)前肌酐水平、腦卒中病史、術(shù)前白細(xì)胞水平、體外循環(huán)時(shí)間、主動(dòng)脈阻斷時(shí)間、深低溫停循環(huán)時(shí)間、術(shù)中峰值血糖和術(shù)中輸血量。其中術(shù)前肌酐水平、術(shù)前白細(xì)胞水平和術(shù)中峰值血糖為術(shù)后TND的獨(dú)立危險(xiǎn)因素;2.與術(shù)后PND相關(guān)的危險(xiǎn)因素包括:年齡、腦卒中病史、主動(dòng)脈阻斷時(shí)間和復(fù)溫時(shí)間。其中:年齡和腦卒中病史為術(shù)后PND的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective to analyze the risk factors of cerebral nerve system complications in patients with acute Stanford A aortic dissection after Sun's operation. Methods 82 cases of acute Stanford A aortic dissection from June 2010 to January 2017 in Dalian Central Hospital from June 2010 to January 2017 were analyzed. 82 patients with Stanford A aortic dissection underwent Sun's operation during deep hypothermia circulatory arrest combined with selective anterograde cerebral perfusion. Circulatory arrest began, and the right axillary artery was perfused with antegrade selective cerebral perfusion. The flow rate was maintained at 5-10 ml / kg / min and the perfusion pressure was 40-60 mmHg.When the rewarming reached 36.6 鈩，

本文編號(hào)：1561396