The Research Of Mild Hypothermia Circulatory Arrest Anesthesia In The Protection Of Liver In Patients With Stanford A Type Aortic Dissection Undergoing Internal Aortic Arch Replacement

Objectives:The Anaesthesiology Department and Cardiovascular Surgery Department of the Second Hospital of Jilin University has been using the internal aortic arch replacement to treat Stanford Type A dissection.The improved surgical method significantly reduced the time of operation and anesthesia,during the operation using mild hypothermia with transient circulatory arrest.This contributes to studying mild hypothermia treatment to reduce the impact of hypothermia on other organs when performing the hypothermia brain protection.In this paper,we study the protective effect and potential contributing factors of mild hypothermia circulatory arrest anesthesia on the livers with Stanford Type A aortic dissection undergoing internal aortic arch replacement.Method:A retrospective analysis was performed on the patients who underwent mild hypothermia circulatory arrest with transient circulatory arrest and moderate hypothermia circulatory arrest with transient circulatory arrest in the Cardiac Surgery Department of the Second Hospital of Jilin University,from January 2017 to December 2021.The patients underwent internal aortic arch replacement for Stanford Type A dissection,brain-body separation and perfusion.The descending aortic balloon occlusion is carried out in operation.The mild hypothermia group had 46 cases with the rectal temperature of 30-32℃.The moderate hypothermia group had 46 cases with the rectal temperature of 26℃-28℃.The preoperative condition of the patients were collected: age,gender,body mass index,body surface area,history(including smoking,drinking,hypertension,diabetes,coronary heart disease,etc.),preoperative neurological function Glasgow score(GSC score),alanine aminotransferase(ALT),aspartate aminotransferase(AST)and total bilirubin(TBIL),prothrombin time(PT).Intraoperative condition: rectal temperature,nasopharyngeal temperature,hypothermia time,ascending aorta occlusion time,circulatory arrest time,rewarming time,cardiopulmonary bypass time,operation time,monitoring the internal jugular vein p H value after twenty minutes from the beginning of cerebral perfusion,carbon dioxide partial pressure(Pjv CO2),partial venous of oxygen pressure(Pjv O2),oxygen saturation(Sj O2).Postoperative condition: time of awakening after operation,time of mechanical ventilation,stroke,transient disturbance of consciousness,spinal cord ischemia,Glasgow(GSC)score and AST,ALT,TBIL,PT value at the first twelve hours,one day,three days,and five days after operation.The levels of tumor necrosis factor-α(TNF-α),interleukin-1β(IL-1β),interleukin-2(IL-2),and interleukin-6(IL-6)were monitored.Results:There was no significant difference in preoperative general information between the mild hypothermia group and the moderate hypothermia group.The patients in the past medical history between the mild hypothermia group and the moderate hypothermia group with no statistical difference.The patients in the preoperative GSC score,ALT,AST,TBIL and PT level between the two groups with no statistical difference.The hypothermia time,rewarming time,cardiopulmonary bypass time and operation time in the mild hypothermia group is significantly shorter than those in the moderate hypothermia group,and the difference is statistically significant.The internal jugular venous blood is collected after twenty minutes of the cerebral perfusion in the two groups.According to the monitoring indicators on the blood gas analyzers,it is shown that there is no significant difference in PH value,Pjv CO2,Pjv O2,and Sj O2 between the mild hypothermia group and the moderate hypothermia group.There is no significant difference in GSC score between the two groups at twelve hours,one day,three days and five days after operation.There is no significant difference in postoperative wake-up time and mechanical ventilation time between the two groups.The incidence rates of stroke,transient disturbance of consciousness,spinal cord ischemia and mortality between the two groups have no statistical difference.The first twelve hours after operation,the ALT level of the mild hypothermia group is significantly lower than that of the moderate hypothermia group,and the statistical difference is significantly.One day after operation,the AST level in the mild hypothermia group is significantly lower than that in the moderate hypothermia group,and the statistical difference is significantly.Five days after operation,the TBIL level of the mild hypothermia group was significantly lower than that of the moderate hypothermia group with no statistical difference.One day after operation,the level of TNF-αin the mild hypothermia group is significantly lower than that in the moderate hypothermia group with no statistical difference.Twelve hours and one day after operation,the level of IL-1β,IL-2 and IL-6 in the mild hypothermia group is significantly lower than that in the moderate hypothermia group with no statistical difference.Conclusion:The patients had the Stanford type A aortic dissection undergoing aortic arch replacement with mild hypothermia anesthesia,which could improve postoperative liver function and reduce liver damage.This might be attributed to the decreased cytokine levels of postoperative systemic inflammatory reaction,reduced liver hypothermia injury,liver hypoperfusion injury and liver ischemia-reperfusion injury,and other potential factors.