Effect of improved blood perfusion intervention on incidence of nervous system dysfunction and heart rate variability in Stanford type A aortic dissection patients undergoing cardiopulmonary bypass

doi:10.3877/cma.j.issn.1674-0785.2021.08.010

Abstract

Abstract:

Objective

To explore the effect of improved blood perfusion intervention on the incidence of neurological dysfunction and heart rate variability (HRV) in patients with Stanford type A aortic dissection undergoing cardiopulmonary bypass.

Methods

A total of 84 patients with Stanford type A aortic dissection undergoing cardiopulmonary bypass at the Department of Cardiovascular Surgery of the Inner Mongolia Autonomous Region People's Hospital from May 2018 to June 2020 were selected as the research subjects. Using a random number table, the patients were divided into a control group (given unilateral antegrade cerebral perfusion treatment) and an observation group (given improved blood flow perfusion treatment), with each group having 42 cases. Intraoperative (time of extracorporeal circulation, surgery time, brain perfusion time, and assisted respiratory time) and postoperative indexes [time to awake, endotracheal intubation time, chest drainage volume, intensive care unit (ICU) stay time, and length of stay], HRV indexes [standard deviation of NN intervals (SDNN), standard deviation average of NN intervals (SDANN), square mean squared difference adjacent NN intervals (RMSSD), and proportion of NN50 divided by the total number of NN intervals (PNN50)], complications, and mortality at 30 days after operation were observed.

Results

The extracorporeal circulation time and operation time of the observation group were not significantly different from those of the control group (P＞0.05), but the cerebral perfusion time, auxiliary breathing time, time to postoperative awake, tracheal intubation time, volume of thoracic drainage 48 h postoperatively, ICU stay time, and postoperative hospital stay of the observation group were significantly lower than those of the control group (P＜0.05 for all). SDNN, SDANN, RMSSD, and PNN50 in the observation group were significantly higher than those of the control group (P＜0.05 for all). The incidence of transient consciousness disorder, hypoxemia, hyperbilirubinemia, and anastomotic bleeding had no statistically significant differences between the two groups (P＞0.05 for all), but the incidence of TND and PND in the observation group was significantly lower than that of the control group (P＜0.05 for all). The mortality at 30 days after operation had no statistically significant difference between the two groups (P＞0.05).

Conclusion

Improved blood perfusion intervention is effective in the treatment of Stanford type A aortic dissecting aneurysm, which can reduce HRV and the risk of neurological dysfunction.

Key words: Improved blood perfusion intervention, Cardiopulmonary bypass, Stanford type A, Aortic dissection, Heart rate variability

Alusi Zhang, Kehe Xia, Lu Zhang, Changyu Li, Linnan Deng, Wei Li. Effect of improved blood perfusion intervention on incidence of nervous system dysfunction and heart rate variability in Stanford type A aortic dissection patients undergoing cardiopulmonary bypass[J]. Chinese Journal of Clinicians(Electronic Edition), 2021, 15(08): 610-614.

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URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2021.08.010

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Figures/Tables 5

组别	例数	性别［例（%）］		年龄（岁， $x ¯$ ±s）	颈动脉内膜中层厚度（mm， $x ¯$ ±s）	丙氨酸转氨酶（U/L， $x ¯$ ±s）	总胆红素（μmol/L， $x ¯$ ±s）	主动脉根部病变分型［例（%）］			主动脉弓病变分型［例（%）］
组别	例数	男性	女性	年龄（岁， $x ¯$ ±s）	颈动脉内膜中层厚度（mm， $x ¯$ ±s）	丙氨酸转氨酶（U/L， $x ¯$ ±s）	总胆红素（μmol/L， $x ¯$ ±s）	A1型	A2型	A3型	C型	S型
观察组	42	20（47.62）	22（52.38）	52.32±2.45	1.05±0.15	15.25±3.25	10.65±1.25	18（42.86）	5（11.9）	19（45.24）	2（4.76）	40（95.24）
对照组	42	21（50.00）	21（50.00）	52.40±2.36	1.08±0.12	15.30±3.19	10.59±1.29	17（40.48）	6（14.29）	19（45.24）	3（7.14）	39（92.86）
统计值		χ²=0.048		t=0.152	t=1.012	t=0.071	t=0.216	χ²=0.119			χ²=0.213
P值		0.827		0.879	0.314	0.943	0.829	0.942			0.645

组别	例数	性别［例（%）］		年龄（岁， $x ¯$ ±s）	颈动脉内膜中层厚度（mm， $x ¯$ ±s）	丙氨酸转氨酶（U/L， $x ¯$ ±s）	总胆红素（μmol/L， $x ¯$ ±s）	主动脉根部病变分型［例（%）］			主动脉弓病变分型［例（%）］
组别	例数	男性	女性	年龄（岁， $x ¯$ ±s）	颈动脉内膜中层厚度（mm， $x ¯$ ±s）	丙氨酸转氨酶（U/L， $x ¯$ ±s）	总胆红素（μmol/L， $x ¯$ ±s）	A1型	A2型	A3型	C型	S型
观察组	42	20（47.62）	22（52.38）	52.32±2.45	1.05±0.15	15.25±3.25	10.65±1.25	18（42.86）	5（11.9）	19（45.24）	2（4.76）	40（95.24）
对照组	42	21（50.00）	21（50.00）	52.40±2.36	1.08±0.12	15.30±3.19	10.59±1.29	17（40.48）	6（14.29）	19（45.24）	3（7.14）	39（92.86）
统计值		χ²=0.048		t=0.152	t=1.012	t=0.071	t=0.216	χ²=0.119			χ²=0.213
P值		0.827		0.879	0.314	0.943	0.829	0.942			0.645

组别	例数	体外循环时间（min）	手术时间（h）	脑灌注时间（min）	辅助呼吸时间（h）
观察组	42	233.45±41.25	7.52±1.25	30.05±1.52	27.52±2.05
对照组	42	239.01±38.98	7.35±1.36	36.78±2.45	31.21±3.65
t值		0.635	0.596	15.127	5.712
P值		0.527	0.553	＜0.001	＜0.001

组别	例数	术后清醒时间（h）	气管插管时间（h）	术后48 h胸腔引流量（ml）	ICU停留时间（h）	术后住院时间（d）
观察组	42	30.15±5.25	46.11±5.65	685.78±125.32	5.81±1.05	17.12±2.32
对照组	42	42.52±8.45	58.95±8.74	825.66±172.32	6.69±1.85	24.52±5.02
t值		8.058	7.996	4.255	2.681	8.672
P值		＜0.001	＜0.001	＜0.001	0.009	＜0.001

组别	例数	SDNN（ms）	SDANN（ms）	RMSSD（ms）	PNN50（%）
观察组	42	123.52±10.52	112.32±7.52	31.11±2.32	8.15±1.52
对照组	42	110.25±7.02	102.35±5.62	23.52±1.05	6.98±1.12
t值		6.800	6.882	19.316	4.016
P值		＜0.001	＜0.001	＜0.001	＜0.001

组别	例数	一过性意识障碍	低氧血症	高胆红素血症	吻合口渗血	TND	PND
观察组	42	1（2.38）	0（0）	0（0）	0（0）	1（2.38）	0（0）
对照组	42	3（7.14）	1（2.38）	2（4.76）	2（4.76）	7（16.67）	4（9.52）
P值^*		0.616	1.000	0.494	0.494	0.057	0.116

References 20

1	唐杨烽, 徐激斌, 谈梦伟, 等. Stanford A型主动脉夹层外科治疗的危险因素分析 [J/OL]. 中华临床医师杂志(电子版), 2012, 6(2): 481-482.
2	王小文, 陈丹, 姜兆磊, 等. 单侧与双侧顺行性脑灌注技术对主动脉手术患者预后影响的系统评价与Meta分析 [J]. 中国胸心血管外科临床杂志, 2020, 27(4): 105-112.
3	赵永波, 岳月红, 王彦芝, 等. 急性Stanford A型主动脉夹层患者的临床特征及术后院内死亡危险因素分析 [J]. 现代生物医学进展, 2019, 19(7): 1362-1366.
4	顾嘉玺, 邵永丰, 倪布清, 等. 急性Stanford A型主动脉夹层孙氏手术后院内死亡危险因素分析 [J]. 南京医科大学学报(自然科学版), 2020, 40(8): 1194-1197.
5	白耀邦, 李培军, 吴振华, 等. Stanford A型主动脉夹层患者术后谵妄的相关危险因素分析 [J]. 天津医药, 2018, 46(5): 471-474.
6	Lin Y, Chen MF, Zhang H, et al. The risk factors for postoperative cerebral complications in patients with Stanford type a aortic dissection [J]. J Cardiothorac Surg, 2019, 14(1): 178.
7	苏晶晶, 刘宏宇, 邓丽, 等. 急性Stanford A型主动脉夹层患者体外循环术后急性肾损伤的危险因素分析 [J]. 中国心血管病研究, 2019, 17(9): 793-797.
8	葛翼鹏, 里程楠, 夏瑀, 等. 急性Stanford A型主动脉夹层孙氏手术后肾脏替代治疗的危险因素 [J]. 中华胸心血管外科杂志, 2019, 35(8): 462-465.
9	Corbett DB, , Fennell C, Peroutky K, et al. The effects of a 12-week worksite physical activity intervention on anthropometric indices, blood pressure indices, and plasma biomarkers of cardiovascular disease risk among university employees [J]. BMC Res Notes, 2018, 11(1): 80.
10	孙煦, 朱悦倩, 安静, 等. Stanford A型主动脉夹层手术中不同脑灌注方式的脑保护效果研究 [J]. 中国体外循环杂志, 2019, 17(2): 72-75.
11	Sultan I, Bianco V, Patel HJ, et al. Surgery for type A aortic dissection in patients with cerebral malperfusion: results from the international registry of acute aortic dissections [J]. J Thorac Cardiovasc Surg, 2021, 161(5): 1713-1720.
12	孙君隽, 胡玲, 杨侃. 改良血流灌注干预方案对行体外循环Stanford A型主动脉夹层动脉瘤病人围术期临床指标及安全性的影响 [J]. 中西医结合心脑血管病杂志, 2020, 18(4): 642-645.
13	姜鑫, 赵悦, 文增瑞, 等. Stanford A型主动脉夹层行全弓置换术后早期死亡危险因素分析 [J]. 中国体外循环杂志, 2020, 18(6): 370-374.
14	卢子润, 范阜东, 薛云星, 等. 急性Stanford A型主动脉夹层合并冠状动脉灌注不良的手术处理 [J]. 中华胸心血管外科杂志, 2018, 34(9): 527-530.
15	崔艳华, 严继萍, 赵文莉, 等. 心肌超声造影对大动脉炎冠状动脉受累患者心肌血流灌注的评价价值 [J/OL]. 中华临床医师杂志(电子版), 2020, 14(8): 599-603.
16	Mozes GD, Pather K, Oderich GS, et al. Outcomes of onyx embolization of type Ⅱ endoleaks after endovascular repair of abdominal aortic aneurysms [J]. Ann Vasc Surg, 2020, 67: 223-231.
17	韩冬, 孙君隽, 张超. 三种脑灌注方案对行深低温停循环Stanford A型主动脉夹层病人围手术期临床指标、神经系统功能障碍发生率及心率变异性水平的影响 [J]. 安徽医药, 2020, 24(11): 2229-2233.
18	弓华, 张海燕, 靳津鸽. 急性Standford A型主动脉夹层围手术期患者发生低血氧症的危险因素及其预测价值 [J]. 中国现代医学杂志, 2020, 30(2): 44-49.
19	于浩, 童光, 颜涛, 等. 优化选择性动脉灌注策略在Stanford A型主动脉夹层全弓置换术中的应用 [J]. 第二军医大学学报, 2018, 39(4): 404-410.
20	Eskandari F, Khatijah LA, Zainal NZ, et al. The effect of educational intervention on nurses' knowledge, attitude, intention, practice and incidence rate of physical restraint use [J]. Nurse Educ Pract, 2018, 32: 52-57.

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