ObjectiveTo evaluate the risk factors and of neurological complications after type DeBakey Ⅰ aortic dissection. MethodsSeventy patients underwent operations of the aortic dissection with deep hypothermic circulatory arrest (DHCA) in combination with antegrade selective cerebral perfusion (ASCP). Perioperative factors were evaluated by means of univariate and multivariate logistic analysis to identify relative risk factors of neurological complications. ResultsOne case was exduded. The extracorporeal circulation time was (158.39 ±47.16) min,the aortic crossclamp time was (99.12 ±46.27) min,the brain stop circulation time was (29.83 ± 6.85 ) min. Neurological complications occurred in 19 patients (27.5％),including 10 patients with temporary cerebral dysfunction, 3 patients with permanent cerebral dysfunction, 2patients with paraplegia,4 patients with hoarseness. Renal and hepatic dysfunction, hypertension disease,aortic crossclamp time ＞ 120 min,circulatory arrest time ＞40 min, blood transfusion volume ＞4000 ml,arterial blood pressure instability ＞ 80 mm Hg ( 1 mm Hg = 0.133 kPa) and postoperative low cardiac output were the risk factors for cerebral complication (P ＜ 0.05 or ＜ 0.01 ). ConclusionsNo single risk factor explains the onset of neurological complications. Cerebral perfusion duration within the limits of safe time and the methods of cerebral perfusion does not influence the neurological complications. Protection of all the endorgans would be helpful to the cerebral protection.

Objective To determine the risk factors for acute kidney injury following type Stanford A Aortic Dissection surgeryies.Methods It's a restrospective study.The clinical data of 176 patients undergoing type Stanford A Aortic Dissection surgery from Septerary 2009 to December 2011 were retrospectively analyzed.There were 115 males and 61 females with mean ages(43.20 ± 10.14)years old.The patients were divided into two groups according to whether AKI occurred after operation.Univariate and multivariate analyses were used to evaluate possible pre-,intra-,and post-operative parameters associated with AKI according to AKI Network.Results Among all the patients,AKI occurred in 78 (44.32％),21 (11.93％) of whom underwent continuous renal replacement therapy (CRRT).In hospital mortality was 3.41％ in all discharges while 6.45％ in AKI patients (P ＜ 0.01).Conclusion Multivariate Logistic regression analysis revealed that increased age,pre-operative left ventricular insufficiency,pre-operative renal insufficiency and long extracorpeal circulation (CPB) time ＞ 140 min were risk factors for the development of AKI.AKI is the most common complication of type Stanford A Aortic Dissection surgery,and is the risk factor of mortality after the surgery.It is important to enhance peri-operative protection of the renal function.

Objective To evaluate the effectiveness and safety of dexmedetomidine for the sedation of the patients after coronary artery bypass grafting (CABG).Methods The selective 96 CABG patients,ASA Ⅱor Ⅲ,aged 36 to 68 years old,58 males and 38 females,were randomly divided into 2 groups (n =48):dexmedetomidine group (group A) and midazolam group (group B).Group A patients received Dexmedetomidine (1.0 μg/kg)over 10 min,followed by 0.2-0.7 μg · kg-1 · h-1 to maintain sedation,whereas the other group patients received midazolam (0.05 mg/kg) over 10 min,followed by 0.02-0.10 mg · kg-1 · h-1 to maintain sedation.Two groups of patients stopped using drug when they were fit off-line and extubation.Observe the percentage of time within target sedative scope (Riker range 3-4),the changes of vital signs before and after treatment,the prevalence of delirium,the awakening time,the duration of mechanical ventilation,ICU length of stay,the adverse events of blood pressure and heart rate.Results There were no significant difference in the percentage of time within target sedative scope between two groups (75.5％ for dexmedetomidine group vs 74.6％ for midazolam group,P ＞ 0.05).Compared to midazolam group,the Dexmedetomidine group has a shorter awakening time [(14.0 ± 6.2) min for dexmedetomidine group vs (50.4 ± 12.8) min for midazolam group,P ＜ 0.05] and duration of mechanical ventilation,and also the prevalence of delirium was lower(15.3％ for dexmedetomidine group vs 34.6％ for midazolam group,P ＜0.05).ICU length of stay was similar.Dexmedetomidine-treated patients were more likely to develop bradcardia,with a non significant increase in the proportion requiring treatment,but had a lower likelihood of tachycardia or hypertension requiring treatment.Conclusion Dexmedetomidine is safe and effective in patients after CABG surgery.

Objective To investgate the proper perioperative management of Debakey Ⅰ aortic dissection by new type of three branches aortic arch covered stent graft implantation. Methods A total of 56cases with Debakey Ⅰ aortic dissection were enrolled into the study and operated by new type of three branches aortic arch covered stent graft implantation from July 2009 to August 2010. Results The cardiopulmonary bypass time during the operation was 90. 0 -248.0 min( median time 180. 6 ains) ,aortic cross clamp time was 69. 0 - 180. 0 min(median time 108. 2 mins) ,circulation arrest time was 17.0 -37.0 min ( median time 22. 6mins) ,the time using reathing apparatus was 16.0 -260.0 hours (median time 42. 8 hours),ICU residence time was 3.0 -23. 0 days( median time 6. 6 days). Fifty-four patients got well and were discharged. One patient died of multi-organ failure postoperatively and another died of large area of acute myocardial infarction. After the operation, six cases had acute renal failure, five cases had tracheotomy, three cases had reoperation for hemorrhage,one case had retardant pericardial tamponade, one case suffered from spinal cord injury, one had cerebral hemorrhage, and five cases had refractory arrhythmias. Conclusion The new type of three branches aortic arch covered stent graft simplified the procedures of aortic arch operation and lowered the operative risk in treatment of Debakey Ⅰ aortic dissection. Properly control of blood pressure and pain before surgery, shorten circulatory arrest time, maintain good organ perfusion seem to be the key points to improve the prognosis in patients with aortic dissection.

0.05).At T9,the Ppeak and PETCO2 in LMA group were significantly higher than those in ET group [(19.0?5.0) mm Hg and(44.7?3.1) mm Hg vs.(13.0?3.0) mm Hg and(34.1?1.9) mm Hg respectively,t=5.636,P=0.000 and t=15.968,P=0.000].In LMA group,5 patients developed adverse reaction,while in the ET group,13 patients showed the reaction(?2=3.774,P=0.052).Conclusions Ventilation with LMA is safe and reliable for elderly patients undergoing laparoscopic surgery with a low rate of adverse reaction.It has slight effect on the hemodynamics of the patients.

Objective To make a systematical review of the safety and efifcacy of Etomidate plus Fentanyl-class drugs and Propofol plus Fentanyl-class drugs in older patients undergoing gastroscopy. Methods We searched the Cochrane library, PubMed, Embase, China Biology Medicine (CBM), CNKI, VIP, Wanfang Database for all randomized controlled trials (RCTs) about the efifcacy of Etomidate plus Fentanyl-class drugs(Fentanyl, Sufentanil, remifentanil) in older patients undergoing gastroscopy. The quality of the studies was evaluated by the method recommended by the Jadad scale. Meta-analysis was conducted using the Cochrane Collaboration’s RevMan 5.3 software. Results 11 RCTs involving 1 535 patients were analyzed. Meta-analysis showed that patients in the Etomidate group had a lower heart rate [Weighted Mean Difference (WMD)=2.25, 95%CI(0.93, 3.56), P=0.001] and mean arterial pressure [WMD=9.09, 95%CI (7.60, 10.57), P=0.000] lfuctuation than whose of the Propofol group.The hypoxemia occurrence [O^R=0.46, 95%CI (0.32, 0.65), P=0.000] in Etomidate group is also lower than which of the Propofol group. For side effects aspects, the risk of apnea[O^R=0.26, 95%CI(0.15, 0.48), P=0.000] and injection pain [O^R=0.02, 95%CI (0.01, 0.05), P=0.000] in the Etomidate group is much lower than the Propofol group ,while the myoclonus [O^R=8.14, 95%CI (4.18, 15.87), P=0.000], nausea and vomiting [O^R=3.44, 95%CI (2.03, 5.84), P=0.000] were more incidental than the Propofol group. Conclusion Etomidate plus Fentanyl-class drugs can effectively maintain circulatory system for the old undergoing painless gastroscopy, demonstrated to be a safe and valid anesthesia method.

Objective This study aims to analyze the independent risk factors associated with postoperative delirium of patients undergoing Stanford A aortic dissection surgery.Methods Clinical data of the patients who underwent Stanford A aortic dissection surgery from December 2014 to October 2015 were collected.All patients received surgery under deep hypothermic circulatory arrest(DHCA) and the nasal temperature goal was below 23℃.After surgery,patients were transferred to the cardiovascular ICU,where they received standard postoperative care.The delirium was diagnosed according to the criteria of the confusion assessment method for the intensive care unit(CAM-ICU).The possible risk factors of pre-operation,during operation or post-operation were analyzed via univariate analysis and multivariate logistic regression to determine the independent risk factorsof postoperative delirium.Results 148 patients underwent Stanford A aortic dissection surgery which the incidence of postoperative delirium was 31.1％ (46/148).Univariate analysis showed the associated risk factors were age,hypertension,cognitive impairment,emergency operation,operation time,aorta clamping time,DHCA time,fluctuation of blood pressure during operation,blood transfusion,quality of sleep,length of ICU stay and electrolyte disturbance(P ＜ 0.05).Multivariate logistic regression analysis revealed that hypertension,cognitive impairment,fluctuation of mean arterial blood pressure(MAP) ＞ 30 mmHg (1 mmHg =0.133 kPa),DHCA time ＞ 40 min,postoperative poor quality of sleep and electrolyte disturbance were independently associated with postoperative delirium after Stanford A aortic dissection surgery(P ＜ 0.05).Conclusion Delirium is a frequent complication.Factors independently associated with delirium are hypertension,cognitive impairment,DHCA time,postoperative poor quality of sleep and electrolyte disturbance.Prevent,assess and manage delirium should be paid more attention and reinforced.

Objective To discuss the clinical epidemiology features and change trend of aortic dissection (AD) in Henan Province.Methods Retrospective analysis of consecutive 906 patients with AD over 10 years in Henan Provincial People' s Hospital,the First Affiliated Hospital of Zhengzhou University and Henan Provincial Chest Hospital.Hospital records and prognosis were compared between two five-year periods.Results 906 cases with AD were hospitalized during the past 10years.The mean age was (50.2 ± 9.8) years.The male/female ratio was 3.49 ∶ 1.Hypertension was present in 60.3 ％ of all patients.Heavy smoking history was elicited in 32.2％ of all patients.Type A dissection were identified in 57.8％ of all the cases,and type B in 42.2％.In-hospital mortality of acute type A dissection was 21.8％,acute type B dissection 6.8％.In two five-year periods,the total number of cases increased by 216％,among which type A was the fastest,increased by 294％,Changes of mean age and male/female ratio were not significant.For acute AD,changes of prognosis in one year improved,and reach statistical significance (P ＜ 0.05).Conclusion This study provides insight into current regional profiles of AD.The number of hospitalized patients with AD is increasing dramatically.The mean age of the first-attack is much younger and the male ration is much higher than that reported by other regional researchers.These data support the urgent need for further improvement in prevention and treatment of AD.

Objective To analyze the incidence rate and the perioperative risk factors associated with delirium after cardiac surgery.Methods We enrolled 622 patients between October 2014 and March 2015 in the department of cardiovascular surgery in Henan Provincial People's Hospital who were allocated to group PD and non-PD according to the Confusion Assessment Method(CAM) after the cardiac operation.Baseline demographics,perioperative data,and postoperative outcomes of these patients were recorded and analyzed via chi-square test and multivariate logistic regression analysis to determine the risk factors of postoperative delirium.Results Postoperative delirium was detected in 102 patients according to CAM criteria.The incidence was 16.4％.Multivariate logistic regression analysis revealed that age (OR =3.456;95％ CI:2.431-4.569),preoperative atrial fibrillation (OR =1.987;95％ CI:3.562-7.862),prolonged surgery duration (OR =1.246;95％ CI:3.164-5.982),postoperative pain (OR =5.356;95 ％ CI:1.386-9.374)were independently associated with postoperative delirium after cardiac surgery.Conclusions Delirium is a frequent complication,age,preoperative atrial fibrillation,prolonged surgery duration,postoperative pain are independent risk factors for delirium following cardiac surgery.Management according to potential risk factors may be associated with preferable therapeutic outcomes.

Objective To explore the risk factors and optional treatment strategies for postoperative hypoxemia in patients undergoing acute Stanford A aortic dissection surgery.Methods From December 2012 to April 2014,108 patients received acute Stanford A aortic dissection surgery in Henan Provincial People' s Hospital.Of them,74 men vs.34 women,age (43.2 ± 10.1) years old,and weight (71.3 ± 18.4) kg.The operation was performed within 14 days since disease onset.All patients received surgery under deep hypothermic circulatory arrest(DHCA) and the nasal temperature goal was below 20 ℃ .Postoperative hypoxemia was defined as the arterial partial oxygen over inspired oxygen fraction(PaO2/FiO2) more than 200 after admission to ICU.Pulmonary protective ventilation management took place immediately after hypoxemia was diagnosed.Comparison analysis was performed between hypoxemia group and non-hypoxemia group in age,gender,body mass index (BMI),smoking history,duration of cardiopulmonary bypass(CPB),duration of DHCA,blood transfusion,length of mechanical ventilation,length of ICU stay and mortality.Results The incidence of postoperative hypoxemia was 40.7％ (44/108).There were no statistical differences in age,gender,hypertension,diabetes mellitus or COPD history.In the hypoxemia group,11 cases developed pulmonary infection,3 cases underwent tracheotomy and 10 cases died.In the non-hypoxemia group,4 patients died.Postoperative hypoxemia was significantly associated with more mortality,length of ventilation time,length of ICU stay and in hospital(P ＞ 0.05).Univariate analysis showed the associated factors were BMI,smoking history,preoperative hypoxemia,LVEF ＜ 0.45,operation time,aorta clamping time,DHCA time and blood transfusion.Multivariate analysis showed the independent predictive factors were preoperative hypoxemia,DHCA ＞40 min,blood transfusion ＞ 10 U and BMI ＞25 kg/ m2.Conclusion Obesity,massive blood transfusion,long DHCA time and preoperative hypoxemia are independent risk factors of postoperative hypoxemia in patients undergoing acute Stanford A aortic dissection surgery.Perioperative pulmonary protection should be paid more attention and reinforced.