Zdravkovic Djordje, Nesic Ivan, Zivkovic Igor Slavoljub, Kaitovic Marko, Vukovic Petar, Milacic Petar
Cardiac Surgery Department, Dedinje Cardiovascular Institute, Beograd, Serbia.
Kardiochir Torakochirurgia Pol. 2020 Jun;17(2):70-75. doi: 10.5114/kitp.2020.97261. Epub 2020 Jul 20.
Technical improvement and new operative strategies significantly influence survival and outcomes after the treatment of acute aortic dissection type A (AADA). However, postoperative complications and particularly neurological dysfunctions (ND) are still very common.
To identify preoperative and intraoperative factors as well as immediate postoperative conditions with an influence on the occurrence of neurological complications of surgical treatment of AADA and accordingly take action to reduce them.
Between January 2013 and December 2018, 240 patients with AADA were emergently surgically treated. All patients were divided into two groups: group I - patients with postoperative ND (subgroup Ia - patients with mild, transient ND and Ib - patients with severe ND) and group II - patients without ND.
Neurological damage after the operation was registered in 87 (39.5%) patients. Thirty (13.6%) patients had mild ND and 57 (25.9%) severe. Presence of preoperative neurological deficit, reduced level of consciousness, supra-aortic vessel dissection, hemodynamic instability, and excessive postoperative bleeding with hypotension are factors with a highly statistically significant association with the occurrence of severe ND. Neurological complications were not identified in 66.7% of patients who were axillary cannulated versus 55.9% of patients cannulated in the other way but the difference did not reach statistical significance ( = 0.1099).
Advanced neuroprotective strategies during surgical treatment of AADA are associated with favorable neurological outcomes, especially in a group of patients with identified risk factors for ND.
技术改进和新的手术策略对急性A型主动脉夹层（AADA）治疗后的生存率和预后有重大影响。然而，术后并发症，尤其是神经功能障碍（ND）仍然非常常见。
确定术前和术中因素以及术后即刻情况对AADA手术治疗神经并发症发生的影响，并据此采取措施减少这些并发症。
2013年1月至2018年12月，对240例AADA患者进行了急诊手术治疗。所有患者分为两组：第一组为术后发生ND的患者（Ia亚组为轻度、短暂性ND患者，Ib亚组为重度ND患者），第二组为未发生ND的患者。
术后有87例（39.5%）患者出现神经损伤。30例（13.6%）患者有轻度ND，57例（25.9%）患者有重度ND。术前存在神经功能缺损、意识水平降低、主动脉弓上血管夹层、血流动力学不稳定以及术后出血过多伴低血压等因素与重度ND的发生具有高度统计学意义的相关性。腋动脉插管患者中66.7%未出现神经并发症，其他插管方式的患者中这一比例为55.9%，但差异无统计学意义（P = 0.1099）。
AADA手术治疗期间先进的神经保护策略与良好的神经预后相关，尤其是在一组已确定有ND危险因素的患者中。
