Analysis Of Risk Factors Of Cerebral Neurological Injury After Acute Operation Of DeBakey Type Ⅰ Aortic Dissection

Background and PurposeAortic dissection(AD)is one of the life-threatening acute cardiovascular diseases.Aortic dissection refers to the tearing of the intima and part of the middle layer of the aortic wall to form an intima tear port through which blood in the aortic lumen enters the middle layer.Under the drive of aortic pressure,blood forms different degrees and ranges of middle layer dissection.According to the location and scope of dissection of aortic dissection,it can be divided into DeBakey Ⅰ,Ⅱ,Ⅲaortic dissection,or Stanford A and B aortic dissection.DeBakey type I aortic dissection refers to the dissection that starts from the ascending aortic root and invades most or all of the aorta,including the aortic arch and part or all of the descending aorta.Among them,acute DeBakey I aortic dissection(within 14 days of onset)is the most dangerous and has a high mortality rate.The main treatment method is surgical treatment,but the scope of surgical trauma is large,the surgical process is complicated,and there are many links.Perioperative Complications are numerous and critical.With the continuous improvement of surgical techniques,anesthesia,and extracorporeal circulation techniques in recent years,although the postoperative mortality rate has decreased,neurological dysfunction ND,including temporary neurological dysfunction(TND)and permanent neurological dysfunction(PND),the incidence is still high after acute DeBakey type I surgery,which will not only prolong the hospital stay of patients,but also increase medical costs and reduce the quality of life of patients.This study reviewed and analyzed relevant clinical data of patients with acute DeBakey type I aortic dissection,explored the occurrence of postoperative cerebral neurological complications,and analyzed related risk factors that affect its occurrence,with a view to providing a basis for clinical prediction and timely intervention.Materials and MethodsThe clinical data of 85 patients with acute DeBakey type I aortic dissection who underwent surgical treatment from January 2016 to April 2019 in the First Affiliated Hospital of Zhengzhou University were collected.All patients were confirmed by 64-row aorta CTA before operation.Deep hypothermic circulatory arrest and selective antegrade unilateral cerebral perfusion were used as brain protection strategies during operation.According to the postoperative neurological complications(ND),patients were divided into transient neurological dysfunction(TND)group and non-transient neurological dysfunction(non-TND)group,permanent neurological dysfunction(PND)group and non-permanent neurological dysfunction(non-PND)group.The related factors of TND and PND appearing in the opponent after operation were analyzed by univariate analysis,and the variables with statistical difference in univariate analysis were analyzed by multivariate logistic regression to find the independent risk factors that affect the occurrence of postoperative TND and PND.Statistical methodAll data were analyzed by SPSS 22.0 software.Normal distribution measurement data are expressed as x±s,non-normal distribution data are expressed as median and quartiles,and comparison between groups is performed using independent sample t test;classification data are expressed as numerical values(%),and comparison between groups adopts χ2 test or Fisher’S exact test.The variables with statistical significance in univariate analysis were introduced into multivariate logistic regression to analyze the correlation of risk factors.The difference was statistically significant atp<0.05.Results1.Postoperative neurological complications occurred in 24 cases(28.2%),including 16 cases(18.8%)of TND and 8 cases(9.4%)of PND.2.The results of univariate analysis showed that there was a significant difference in the cardiopulmonary bypass time,aortic occlusion time and deep hypothermic circulatory arrest time between the TND group and the non-TND group(p<0.05).There was a significant difference between the PND group and the non-PND group in the cardiopulmonary bypass time and femoral artery intubation to establish cardiopulmonary bypass(p<0.05).3.Logistic regression multivariate analysis showed that the deep hypothermic circulatory time(OR=1.568,p=0.007)was a risk factor for TND after acute Debakey I aortic dissection.Choosing Femoral artery intubation to establish cardiopulmonary bypass(OR=9.338,p=0.045)and cardiopulmonary bypass time(OR=1.019,p=0.047)were risk factors for PND after acute Debakey I aortic dissection.ConclusionProlonged deep hypothermic circulatory time during operation indicates a higher incidence of TND,and femoral artery intubation to establish cardiopulmonary bypass and prolonged cardiopulmonary bypass time may indicate a higher incidence of PND.Minimizing the deep hypothermia circulatory time during operation may reduce the incidence of postoperative TND.Avoiding femoral artery intubation to establish cardiopulmonary bypass and shortening the cardiopulmonary bypass time during operation may reduce the incidence of postoperative PND.