摘要
目的探讨改良血流灌注干预对行体外循环Stanford A型主动脉夹层患者神经系统功能障碍发生率及心率变异性(HRV)指标的影响。方法选取2018年5月至2020年6月84例于内蒙古自治区人民医院心血管外科诊治的体外循环Stanford A型主动脉夹层患者作为研究对象,采用随机数字表法分为对照组(予以单侧顺行性脑灌注)与观察组(予以改良血流灌注),各42例。观察术中(体外循环时间、手术时间、脑灌注时间、辅助呼吸时间)及术后(清醒时间、气管插管时间、胸腔引流量、ICU停留时间、住院时间)相关指标、HRV指标[正常R-R间期标准差(SDNN)、每5分钟正常R-R间期平均值标准差(SDANN)、相邻正常R-R间期差的均方根(RMSSD)、一定时间内相邻两个正常心动周期差值>50 ms的心搏数占全程心搏数的百分比(PNN50)]、并发症情况、术后30 d病死率。结果观察组体外循环时间、手术时间与对照组相比,差异均无统计学意义(P>0.05);观察组脑灌注时间、辅助呼吸时间、术后清醒时间、气管插管时间、术后48 h胸腔引流量、ICU停留时间、术后住院时间均少于对照组,差异均有统计学意义(P均<0.05)。观察组SDNN、SDANN、RMSSD、PNN50高于对照组,差异均有统计学意义(P均<0.05)。观察组一过性意识障碍、低氧血症、高胆红素血症、吻合口渗血等发生率与对照组比较,差异均无统计学意义(P均>0.05);观察组短暂性神经系统功能障碍(TND)和永久性神经系统功能障碍(PND)发生率低于对照组,差异均有统计学意义(P均<0.05)。观察组术后30 d病死率与对照组比较无统计学差异(P>0.05)。结论改良血流灌注干预治疗Stanford A型主动脉夹层效果显著,既能降低HRV,又能减少神经系统功能障碍发生风险。
Objective To explore the effect of improved blood perfusion intervention on the incidence of neurological dysfunction and heart rate variability(HRV)in patients with Stanford type A aortic dissection undergoing cardiopulmonary bypass.Methods A total of 84 patients with Stanford type A aortic dissection undergoing cardiopulmonary bypass at the Department of Cardiovascular Surgery of the Inner Mongolia Autonomous Region People's Hospital from May 2018 to June 2020 were selected as the research subjects.Using a random number table,the patients were divided into a control group(given unilateral antegrade cerebral perfusion treatment)and an observation group(given improved blood flow perfusion treatment),with each group having 42 cases.Intraoperative(time of extracorporeal circulation,surgery time,brain perfusion time,and assisted respiratory time)and postoperative indexes[time to awake,endotracheal intubation time,chest drainage volume,intensive care unit(ICU)stay time,and length of stay],HRV indexes[standard deviation of NN intervals(SDNN),standard deviation average of NN intervals(SDANN),square mean squared difference adjacent NN intervals(RMSSD),and proportion of NN50 divided by the total number of NN intervals(PNN50)],complications,and mortality at 30 days after operation were observed.Results The extracorporeal circulation time and operation time of the observation group were not significantly different from those of the control group(P>0.05),but the cerebral perfusion time,auxiliary breathing time,time to postoperative awake,tracheal intubation time,volume of thoracic drainage 48 h postoperatively,ICU stay time,and postoperative hospital stay of the observation group were significantly lower than those of the control group(P<0.05 for all).SDNN,SDANN,RMSSD,and PNN50 in the observation group were significantly higher than those of the control group(P<0.05 for all).The incidence of transient consciousness disorder,hypoxemia,hyperbilirubinemia,and anastomotic bleeding had no statistically significant differences between the two groups(P>0.05 for all),but the incidence of TND and PND in the observation group was significantly lower than that of the control group(P<0.05 for all).The mortality at 30 days after operation had no statistically significant difference between the two groups(P>0.05).Conclusion Improved blood perfusion intervention is effective in the treatment of Stanford type A aortic dissecting aneurysm,which can reduce HRV and the risk of neurological dysfunction.
作者
张阿露斯
夏克何
张琭
李昌玉
邓霖楠
李伟
Zhang Alusi;Xia Kehe;Zhang Lu;Li Changyu;Deng Linnan;Li Wei(Department of Cardiovascular Surgery,Inner Mongolia Autonomous Region People's Hospital,Huhhot 010017,China)
出处
《中华临床医师杂志（电子版）》
CAS
北大核心
2021年第8期610-614,共5页
Chinese Journal of Clinicians(Electronic Edition)
基金
2017年度自治区卫生计生科研计划项目(201702002)。
