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斯坦福A型主动脉夹层手术中中度低温与深度低温麻醉对脑损伤影响的随机对照试验

Randomized controlled trial of moderate hypothermia versus deep hypothermia anesthesia on brain injury during Stanford A aortic dissection surgery.

作者信息

Sun Xufang, Yang Hua, Li Xinyu, Wang Yue, Zhang Chuncheng, Song Zhimin, Pan Zhenxiang

机构信息

Department of Anesthesiology, The Second Hospital of Jilin University, No. 218 Ziqiang Street, Nanguan District, Changchun, 130041, Jilin, China.

出版信息

Heart Vessels. 2018 Jan;33(1):66-71. doi: 10.1007/s00380-017-1037-9. Epub 2017 Aug 23.

Abstract

This study aimed to compare the effects of moderate versus deep hypothermia anesthesia for Stanford A aortic dissection surgery on brain injury. A total of 82 patients who would undergo Stanford A aortic dissection surgery were randomized into two groups: moderate hypothermia group (MH, n = 40, nasopharyngeal temperature 25 °C, and rectal temperature 28 °C) and deep hypothermia group (DH, n = 42, nasopharyngeal temperature 20 °C, and rectal temperature 25 °C). Different vascular replacement techniques including aortic root replacement, Bentall, and Wheat were used. The intraoperative and postoperative indicators of these patients were recorded. There were no differences in intraoperative and postoperative measures between MH and DH groups. The concentrations of neuron-specific enolase and S-100β increased with operation time, and were significantly lower in MH group than those in the DH group (P < 0.05). The occurrence rates of complications including chenosis, postoperative agitation, and neurological complications in MH group were significantly lower than in DH group. The recovery time, postoperative tube, and ICU intubation stay were significantly shorter in MH group than those in DH group (P < 0.05). There were no significant differences revealed in hospital stay and death rate. MH exhibited better cerebral protective effects, less complications, and shorter tube time than DH in surgery for Stanford A aortic dissection.

摘要

本研究旨在比较中度低温麻醉与深度低温麻醉对斯坦福A型主动脉夹层手术脑损伤的影响。共有82例拟行斯坦福A型主动脉夹层手术的患者被随机分为两组:中度低温组(MH,n = 40,鼻咽温度25℃,直肠温度28℃)和深度低温组(DH,n = 42,鼻咽温度20℃,直肠温度25℃)。采用了不同的血管置换技术,包括主动脉根部置换、Bentall手术和Wheat手术。记录这些患者的术中及术后指标。MH组和DH组在术中及术后测量指标方面无差异。神经元特异性烯醇化酶和S-100β的浓度随手术时间增加,且MH组显著低于DH组(P < 0.05)。MH组包括睑裂缩小、术后躁动和神经并发症等并发症的发生率显著低于DH组。MH组的恢复时间、术后置管时间和重症监护病房插管停留时间显著短于DH组(P < 0.05)。住院时间和死亡率无显著差异。在斯坦福A型主动脉夹层手术中,与DH相比,MH表现出更好的脑保护作用、更少的并发症和更短的置管时间。

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