發(fā)布時間：2018-12-28 20:01

【摘要】：目的:觀察依達拉奉聯(lián)合烏司他丁對A型主動脈夾層(AAD)全弓置換術(shù)患者的腦保護作用。方法:前瞻性分析2014-09至2016-01于我中心連續(xù)收治行全弓置換術(shù)治療的AAD患者60例。將圍術(shù)期使用依達拉奉和烏司他丁的30例患者為用藥組,用藥方法:(1)入院至術(shù)后3天:烏司他丁30萬U/8 h,依達拉奉0.5mg/(kg·12 h);(2)體外循環(huán)中:烏司他丁30萬U/2 h,依達拉奉0.5 mg/kg;未使用依達拉奉和烏司他丁的30例患者為非用藥組。觀察指標:(1)術(shù)中:手術(shù)時間、體外循環(huán)時間、選擇性順行腦灌注時間、心臟停搏時間、最低直腸溫度以及雙側(cè)選擇性順行腦灌注(BACP)、單側(cè)選擇性順行腦灌注(UACP)例數(shù);(2)腦損傷血液檢測指標:兩組患者于切皮時(T0)、開放主動脈時(T1)、停轉(zhuǎn)流時(T2)、術(shù)后入重癥監(jiān)護病房時(T3)、術(shù)后24 h(T4)、術(shù)后3d(T5)時S-100和神經(jīng)元特異性烯醇化酶(NSE)水平;(3)術(shù)后臨床指標:住院時間、機械通氣時間、中國臨床神經(jīng)功能缺損程度評分量表(CSS)評分、永久性神經(jīng)功能缺損(PND)、一過性神經(jīng)功能缺損(TND)例數(shù)和院內(nèi)死亡例數(shù)。結(jié)果:用藥組和非用藥組患者在手術(shù)時間、體外循環(huán)時間、心臟停搏時間、選擇性順行腦灌注時間、BACP和UACP方式選擇、術(shù)中最低直腸溫度差異無統(tǒng)計學意義。兩組患者T0時相S-100和NSE差異無統(tǒng)計學意義;與非用藥組比較,用藥組術(shù)后T1至T5時相S-100和NSE較低(P0.05)。兩組患者住院時間,手術(shù)后機械通氣時間、PND和TND發(fā)生例數(shù)、出院前CSS評分中型以上神經(jīng)功能障礙≥16分的例數(shù)和院內(nèi)死亡例數(shù)差異無統(tǒng)計學意義(P均0.05)。結(jié)論:依達拉奉聯(lián)合烏司他丁對AAD行全弓置換術(shù)患者有腦保護作用,能降低腦損傷血液特異指標表達,但是否具有臨床意義有待進一步研究。
[Abstract]:Aim: to observe the brain protective effect of Edaravone combined with ulinastatin on patients with type A aortic dissection undergoing (AAD) total arch replacement. Methods: a prospective analysis of 60 patients with AAD underwent total arch replacement from 2014-09 to 2016-01 in our center. 30 patients who were treated with Edaravone and ulinastatin during perioperative period were treated with: (1) admission to 3 days after operation: ulinastatin 300000 U / 8 h, Edaravone 0.5mg/ (kg 12 h);) (2) during cardiopulmonary bypass, 30 patients with ulinastatin 300000 U / 2 h and Edaravone 0.5 mg/kg; without Edaravone and ulinastatin were not treated. Outcome measures: (1) Intraoperative: operative time, cardiopulmonary bypass time, selective anterograde cerebral perfusion time, cardiac arrest time, minimum rectal temperature and bilateral selective anterograde cerebral perfusion (BACP), Cases of unilateral selective anterograde cerebral perfusion with (UACP); (2) Blood index of brain injury: two groups of patients were treated at incision (T 0), aorta opening (T 1), bypass arrest (T 2), admission to intensive care unit (T 3), 24 h after operation (T 4). The levels of S-100 and neuron-specific enolase (NSE) were observed 3 days after operation (T5). (3) postoperative clinical indicators: duration of hospitalization, time of mechanical ventilation, (CSS) score of Chinese clinical neurological impairment scale, (PND), of permanent neurological impairment The number of patients with transient neurological impairment (TND) and nosocomial death. Results: there was no significant difference in operation time, cardiopulmonary bypass time, cardiac arrest time, selective anterograde cerebral perfusion time, choice of BACP and UACP mode, and the lowest rectal temperature during operation. There was no significant difference in S-100 and NSE between the two groups at T0, and the levels of S-100 and NSE at T1 to T5 after operation were lower in the treated group than in the non-medication group (P0.05). There was no significant difference between the two groups in the hospitalization time, the time of mechanical ventilation after operation, the occurrence of PND and TND, the number of patients with neurological dysfunction 鈮，

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