Risk factors and treatments for neurological complications after deep hypothermic ciculatory arrest operation
10.3760/cma.j.issn.1008-1372.2014.07.003
- VernacularTitle:深低温停循环术后神经并发症危险因素及防治
- Author:
Zhonghua FEI
;
Chuanwen LI
;
Jie QIU
;
Hongsheng LIU
;
Dongwen MA
;
Yanlin CHU
- Publication Type:Journal Article
- Keywords:
Aneurysm,dissecting/surgery;
Aortic diseases/surgery;
Aortic aneurysm/surgery;
Postoperative complications;
Circulatory arrest,deep hypothermia induced;
Central nervous system;
Risk factors
- From:
Journal of Chinese Physician
2014;(7):871-874
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the risk factors for neurological complications after deep hypothermic ciculatory arrest (DHCA) operation.Methods From January 2009 to October 2013, 70 patients who were diagnosed as aortic dissection or aortic an-eurysm underwent aortic operations under DHCA .According to the occurrence of neurological complications after surgery , patients were divided into neurological complication group (26 patients) and normal group (44 patients).Risk factors of neurological complications after surgery were evaluated by univariate analysis and multivariate logistic regression analysis .Results Central neurological compli-cations occurred in 26 patients (37.14%) , including 18 patients with temporary neurological dysfunction and 7 patients with perma-nent neurological dysfunction , 1 patient with paraplegia , 1 patient died of cerebral infarction .Univariate analysis showed that hyperten-sion disease( P =0.001), emergency surgery within 72 hours( P =0.009),cardiopulmonary bypass time ( P =0.015),antegrade se-lective cerebral perfusion ( ASCP) ( P =0.005 ) , hemodilution degree ( P =0.001 ) , erythrocyte ( P =0.033 ) and plasma ( P =0.034 ) transfusion volume in the perioperative period , oxygen index <200 mmHg in 4 hours postoperatively ( P =0.043 ) , arterial blood pressure instability ( P =0.037 ) and hypernatremia in 24 hours postoperatively ( P =0.001 ) , and the Acute Physiology And Chronic Health Evaluation II (APACHE II) score are the risk factors for central neurological complication .Hypertension disease( P =0.017 ) , emergency surgery within 72 hours ( P =0.048 ) , ASCP ( P =0.015 ) , hypernatremia in 24 hours postoperatively ( P =0.008 ) were independent determinats for central neurological complication .Conclusions A series of procedure including evaluating patients condition correctly before operation , controlling hypertension effectively in the perioperative period , applying the ASCP and the suitable hemodilution degree in operation , maintaining electrolyte balance , and correcting hypernatremia timely in the postoperative pe-riod maybe reduce the incidence of neurological complications after DHCA operation .
