在深低温停循环并选择性顺行性脑灌注下行主动脉弓手术后延迟苏醒的危险因素。
Risk factors of delayed awakening after aortic arch surgery under deep hypothermic circulatory arrest with selective antegrade cerebral perfusion.
作者信息
Wang Zhe-Yan, Gu Wan-Jie, Luo Xuan, Ma Zheng-Liang
机构信息
Department of Anesthesiology, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing 210008, China.
出版信息
J Thorac Dis. 2019 Mar;11(3):805-810. doi: 10.21037/jtd.2019.02.01.
BACKGROUND
To determine the risk factors of delayed awakening following aortic arch surgery under deep hypothermic circulatory arrest (DHCA) in combination with selective antegrade cerebral perfusion (SACP).
METHODS
We retrospectively analyzed the clinical data of all patients who underwent aortic arch surgery under DHCA + SACP between September 2015 and September 2017 in our hospital. Delayed awakening was defined as recovery of consciousness later than 24 hours after the surgery. Risk factors of delayed awakening were evaluated using multivariate logistic regression analysis.
RESULTS
A total of 168 subjects were included. In-hospital mortality of the overall sample was 19.05% (n=32). Delayed awakening occurred in 76 (45.23%) subjects. Subjects with delayed awakening had older age, hypertension, higher rate of emergency surgery and blood transfusion, and longer cardiopulmonary bypass (CPB) time and myocardial blocking time. Multivariate regression analysis showed emergency surgery (P=0.005) and CPB time >240 min (P<0.001) as risk factors for delayed awakening, even after adjusting potential confounders, including age, hypertension, aortic cross-clamp time and blood transfusion.
CONCLUSIONS
In patients undergoing aortic arch surgery under DHCA + SACP, emergency surgery and CPB time >240 min are risk factors for delayed awakening.
背景
确定在深低温停循环（DHCA）联合选择性顺行脑灌注（SACP）下行主动脉弓手术术后延迟苏醒的危险因素。
方法
我们回顾性分析了2015年9月至2017年9月在我院接受DHCA + SACP主动脉弓手术的所有患者的临床资料。延迟苏醒定义为术后24小时后意识恢复。采用多因素logistic回归分析评估延迟苏醒的危险因素。
结果
共纳入168例患者。总体样本的院内死亡率为19.05%（n = 32）。76例（45.23%）患者发生延迟苏醒。发生延迟苏醒的患者年龄较大、患有高血压、急诊手术和输血率较高，体外循环（CPB）时间和心肌阻断时间较长。多因素回归分析显示，即使在调整了包括年龄、高血压、主动脉阻断时间和输血等潜在混杂因素后，急诊手术（P = 0.005）和CPB时间>240分钟（P < 0.001）仍是延迟苏醒的危险因素。
结论
在接受DHCA + SACP主动脉弓手术的患者中，急诊手术和CPB时间>240分钟是延迟苏醒的危险因素。
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