The correlation between intraoperative temperature and postoperative neurological prognosis in aortic arch surgery: a single-center retrospective cohort study
10.3760/cma.j.cn112434-20210829-00290
- VernacularTitle:主动脉弓部手术降温温度与神经系统预后的相关性研究：单中心回顾性队列研究
- Author:
Kai ZHU
1
;
Xudong PAN
;
Songbo DONG
;
Jun ZHENG
;
Yongmin LIU
;
Sihong ZHENG
;
Lizhong SUN
Author Information
1. 首都医科大学附属北京安贞医院心外科 北京市心肺血管疾病研究所 北京市大血管疾病诊疗研究中心 北京市大血管外科植入式人工材料工程技术研究中心，北京 100029
- Keywords:
Aortic arch surgery;
Low temperature stops circulation;
Neurological complications
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2022;38(4):223-229
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To explore the correlation between intraoperative cooling temperature and postoperative neurological prognosis in aortic arch surgery.Methods:We observed and collected data from 118 patients who underwent open arch replacement surgery by a single surgeon with mild-to-moderate hypothermic circulatory arrest, from January 2017 to December 2020, in Beijing Anzhen Hospital. According to the bladder temperature during the circulation arrest, 118 patients were divided into 3 groups: T1 group[n=39, (25.58±0.64)℃]; T2 group[n=39, (28.21±0.77)℃]; T3 group[n=40, (30.95±0.97)℃]. Clinical data and operative data were analyzed to assess difference between these 3 groups. Analyze the risk factors of postoperative neurological complications, and explore further the correlation between intraoperative core temperature and postoperative neurological prognosis.Results:Among the 118 patients, the average operation, cardiopulmonary bypass (CPB), block, circulatory arrest, and selective cerebral perfusion (SCP) time were 6.64 h, 188.5 min, 104.19 min, 23.93 min, 28.81 min, respectively. The in-hospital death occurred in 8 patients(6.78%), and permanent neurological dysfunction (PND) in 13 patients(11.02%), transient neurological dysfunction (TND) in 25 patients(21.19%). There was no significant difference in the deaths among the three groups. The incidence of TND and PND in the T3 group was significantly reduced ( P=0.042; P=0.045). In addition, the volume of drainage during the first 24 h and the incidence of re-exploration for bleeding had a relatively obvious decreasing trend ( P=0.005; P=0.012). Through multiple regression analysis, under the adjusted model, the core temperature was independently correlated with the incidence of postoperative PND ( OR=0.51; 95% CI: 0.27-0.97; P=0.0389); in group comparison, the relatively higher core temperature was an independent protective factor for postoperative PND ( OR=0.04; 95% CI: 0.00-0.91; P=0.0434). Conclusion:Our research had preliminary proved that in the open arch replacement surgery, mild hypothermia can reduce the incidence of some complications of deep hypothermia, at the same time improve the prognosis of the neurological prognosis, reduce the incidence of postoperative PND.
