Clinical Study On Cerebral Protection Of Unilateral And Bilateral Cerebral Perfusion In Operations Of Aortic Arch Replacement In Acute Stanford Type A Aortic Dissection

Objective To compare the clinical effects on cerebral protection of unilateral selective cerebral perfusion(USCP)and bilateral selective cerebral perfusion(BSCP)in operations of aortic arch replacement in Stanford type A aortic dissection,and to investigate the related risk factors in the appearance of postoperative neurological dysfunction.Methods Analyzing materials of patients who accepted operations performed by the same operator in cardiovascular surgery of Qilu Hospital of Shandong University from January 2015 to December 2016.The patients were divided into two groups,which were named the USCP group and the BSCP group,according to different modes of cerebral perfusion.This dissertation analyzed the patients’ ages,weight,preoperative complications.surgical methods,CPB time in operations,aortic cross-clamping time,MHCA time,postoperative revival time,postoperative intubation time,neurological dysfunction and prognosis.Student t test,chi-square test and multivariate Logistic regression analysis were used to compare the differences in postoperative neurological dysfunction between the USCP group and the BSCP group,and furthermore to analyze the association between patients’ clinical materials and postoperative neurological dysfunction.Results There were totally 114 acute Stanford type A aortic dissection patients who accepted aortic arch replacement operations performed by the same operator.Among all the patients,32of them belonged to the USCP group and 82 belonged to BSCP group.The morbidity of postoperative neurological dysfunction of the two groups were 46.88%(TND 28.13%,PND 18.75%)and 15.85%(TND 12.2%,PND 3.66%)respectively.The postoperative revival time differentiated from 15:11 ±14:36(h)from 9.02 ±8.07(h)and curative and improving rate were separately 81.25%and 93.90%,which manifested that the differences had statistical significance(P<0.05).The risk factors of multivariate Logistic regression analysis were preoperative nervous system conditions(OR:6.80),modes of cerebral perfusion(OR:3.81)and intraoperative assisted circulation time(OR:1.04).Conclusion In aortic arch replacement operations of acute Stanford type A aortic dissection:1.BSCP could effectively reduce morbidity of postoperative neurological dysfunction.It is safer and more reliable;2.The risk factors of postoperative neurological dysfunction were preoperative nervous system conditions,way of cerebral perfusion and assisted circulation time;3.Postoperative neurological dysfunction were related to AD subtypes,MHCA temperatures of patients to some extent;4.Postoperative neurological dysfunction were to a certain degree relevant to postoperative revival time and prognosis.