Effect of different types of cerebral perfusion for acute type A aortic dissection undergoing aortic arch procedure, unilateral versus bilateral.
Effect of different types of cerebral perfusion for acute type A aortic dissection undergoing aortic arch procedure, unilateral versus bilateral.
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DOI：
10.1186/s12893-020-00957-8
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发表时间：
2020-11-18
期刊：
影响因子：
1.9
通讯作者：
Pang X
中科院分区：
文献类型：
--
作者：
Liu Z;Wang C;Zhang X;Wu S;Fang C;Pang X
顺行脑灌注（ACP），包括单侧和双侧，是主动脉手术中最常用的脑保护方法。对于这两种方法的优越性还没有达成共识。本研究旨在探讨u-ACP和b-ACP的临床疗效。对356例A型主动脉夹层患者中的321例进行回顾性分析。u-ACP 124例（38.6%），b-ACP 197例（61.4%）。我们比较了两组患者术后神经系统并发症的发生率和其他收集到的数据。此外，我们还分析了围手术期变量，以寻找神经功能障碍（ND）的潜在相关因素。u-ACP组术后神经系统并发症54例（43.5%），其中永久性神经功能障碍（PND） 22例（17.7%），暂时性神经功能障碍（TND） 32例（25.8%）。b-ACP组术后神经系统并发症47例（23.8%），其中PND 16例（8.1%），TND 31例（15.7%）。两组患儿PND、TND的发生率均以CPB时间较短（p = 0.016）、鼻咽温度较高（p≦0.000）、通气时间较短（p = 0.018）、缺氧发生率较低（p = 0.022）差异有统计学意义。此外，多因素逐步logistic回归分析证实，术前神经功能障碍（OR = 1.20, p = 0.028）、CPB持续时间（OR = 3.21, p = 0.002）和脑灌注类型（OR = 1.48, p = 0.017）与术后ND密切相关。在我们的研究中，我们观察到与u-ACP相比，b-ACP手术表现出更短的CPB时间，更轻的低体温，更短的通气时间，更低的术后缺氧发生率和神经功能障碍。同时，ND的发生与术前神经功能障碍、CPB时间、脑灌注类型三个因素独立相关。
Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research aimed to investigate the clinical effects of u-ACP and b-ACP. 321 of 356 patients with type A aortic dissection were studied retrospectively. 124 patients (38.6%) received u-ACP, and 197 patients (61.4%) received b-ACP. We compared the incidence of postoperative neurological complications and other collected data between two groups. Besides, we also analyzed perioperative variables to find the potential associated factors for neurological dysfunction (ND). For u-ACP group, 54 patients (43.5%) had postoperative neurological complications, including 22 patients (17.7%) with permanent neurologic dysfunction (PND) and 32 patients (25.8%) with temporary neurologic dysfunction (TND). For b-ACP group, 47 patients (23.8%) experienced postoperative neurological complications, including 16 patients (8.1%) of PND and 31 patients (15.7%) of TND. The incidence of PND and TND were significantly different between two groups along with shorter CPB time (p = 0.016), higher nasopharyngeal temperature (p≦0.000), shorter ventilation time (p = 0.018), and lower incidence of hypoxia (p = 0.022). Furthermore, multivariate stepwise logistic regression analysis confirmed that preoperative neurological dysfunction (OR = 1.20, p = 0.028), CPB duration (OR = 3.21, p = 0.002), and type of cerebral perfusion (OR = 1.48, p = 0.017) were strongly associated with postoperative ND. In our study, it was observed that b-ACP procedure exhibited shorter CPB time, milder hypothermia, shorter ventilation time, lower incidence of postoperative hypoxia, and neurological dysfunction compared to u-ACP. Meanwhile, the incidence of ND was independently associated with three factors: preoperative neurological dysfunction, CPB time, and type of cerebral perfusion.
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影响因子：
3.4
作者：
González-Ibarra FP;Varon J;López-Meza EG
通讯作者：
López-Meza EG
影响因子：
4.6
作者：
Olsson, C;Thelin, S
通讯作者：
Thelin, S
DOI：
10.1510/mmcts.2006.001974
发表时间：
2007-01-01
期刊：
Multimedia manual of cardiothoracic surgery : MMCTS
影响因子：
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作者：
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通讯作者：
Ueda, Yuichi
影响因子：
4.6
作者：
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通讯作者：
Griepp, RB
影响因子：
3.4
作者：
Harrer, Marieluise;Waldenberger, Ferdinand Rudolf;Grabenwoeger, Martin
通讯作者：
Grabenwoeger, Martin