Logistic Regression Analysis Of The Risk Factors For Cerebral Neurological Injury After Operation Of Acute Stanford Type A Aortic Dissection

Objective To analyze related risk factors for cerebral neurological system after operation of acute Stanford type A aortic dissection.Methods Between June 2010 and January 2017,82 cases of acute Stanford type A aortic dissection patients in Dalian municipal central hospital cardiac vascular surgery department underwent SUN’procedure(Ascending aorta replacement + Aortic arch replacement + stented elephant trunk)with deep hypothermic circulatory arrest in combinatio-n with selective anterograde cerebral perfusion,when the nasopharyngeal temperature decreased to 25℃,we began to stop cycle,at the same time by the right axillary artery selective cerebral perfusion,the flow rate was maintained with 5～10 ml/kg/min.When the nasopharyngeal temperature was increased to 36.6℃-37.0℃ and the temperature of rectum was increased to 34℃-35℃,we can stop the extracorporeal circulation before the indicators were normal.Statistical and analyze related risk factor,including age,gender,weight,smoking history,diabetes history,history of high blood pressure,stroke history,preoperative white blood cell count,preoperative neurologic symptoms,preoperative serum creatinine,the time from onset to operation,operation time,extracorporeal circulation time,intraoperative aortic block time,the time of deep hypothermia circulatory arrest,minimum oxygen saturation,rewarming time,cooling time,intraoperative peak blood glucose,intraoperative blood transfusion.Univariate and multivariate analysis(multiple logistic regression)were used to identify the risk factors for postoperative cerebral neurological injury including permanent neurological dysfunction(PND)and temporary neurological dysfuction(TND).Results Cerebral neurological injury occurred in 15cases(18.3%),PND 3 cases(3.7%)and TND 12 cases(14.6%).By univariate analysis,we know that age,diabetes history,preoperative neurological symptoms,serum creatinine levels,a history of stroke,preoperative level of white blood cells,extracorporeal circulation time,aorta blocking total time,deep hypothermic circulatory arrest time,intraoperative blood glucose value and highest amount of intraoperative blood transfusion is the related risk factors for postoperative TND(P<0.1),and age,history of stroke,aortic block time,rewarming time is the related risk factors for postoperative PND(P<0.1);Multiple logistic regression showed that the independent risk factors for PND is age(O∧ R = 1.715,95%C I 1.048 3.024,P = 0.027)and a history of stroke(O∧R = 2.657,95%CI 0.9433.142,P = 0.001).The independent risk factors for TND including preoperative serum creatinine(O∧R = 1.956,95%CI 1.237 2.768,P = 0.022),preoperative white blood cell count(WBC)(O " R = 1.587,95%CI 0.764 to 3.411,P = 0.013)and intraoperative peak blood sugar(O∧ R = 2.108,1.328 3.534,9 5%CIP = 0.007).Conclusion To regressive analyze related factors for cerebral neurological system after operation of acute Stanford type A aortic dissection,it is concluded that:1.The risk factors associated with postoperative TND include:age,diabetes history,preoperative neurological symptoms,preoperative creatinine,stroke history,preoperative WBC level,extracorporeal circulation time,aorta blocking time,deep hypothermic circulatory arrest time,intraoperative peak blood glucose,intraoperative blood transfusion.Including preoperative creatinine,preoperative white blood cell levels and intraoperative peak blood glucose as the independent risk factors for postoperative TND;2.The risk factors associated with postoperative PND include:age,history of stroke,aortic block and thawing time.Age and history of stroke independent risk is the factors for postoperative PND.