The Retrospective Analysis Of The Protection Of Spinal Cord Function With Different Hypothermia Circulation Arrest Anesthesia In Aortic Dissection Surgery

Objective:Compared the incidence of spinal cord dysfunction in deep hypothermia(25℃ group)with moderate hypothermia(28℃ group)during hypothermia circulation arrest in Debakey typeⅠ aortic dissection surgery,to find better way to protect spinal cord.Methods:The study collected 96 Debakey typeⅠ aortic dissection cases from June 2012 to November 2016 in the Second hospital of Jilin University who underwent ascending aortic replacement,modified aortic arch replacement and implantation stent-graft in descending aorta(elephant trunk),45 cases for 25℃ group and 51 cases for 28℃ group,ASA levelⅣ ~ Ⅴ,aged 45 to 69 years old,accepted aorta CTA imaging preoperatively or postoperatively.All of the operations were completed by the same team.Exclusion criteria included the conditions of preoperative consciousness disturbance,preoperative paraplegia or hemiplegia history,physical disabilities,shock or acute myocardial infarction,transient or persistent ischemia attack and death in the first postoperative day.Analyze statistically the patients’ relevant dataincluding preoperative general conditions,blood vessels involved by aortic dissection,operating time,cardiopulmonary bypass time,aortic cross-clamp time,circulatory arrest time,cooling time,rewarming time,lowest temperature,recovery time,operation implications,incidence of postoperative body sensory and motor abnormalities in both groups.Patients with nervous system symptoms should get explicit diagnosis and proper treatment timely.Apply muscle strength grading scale to evaluate the muscle strength of patients with spinal motor dysfunction and ASIA sensory evaluation method to estimate the sensation of patients with spinal sensory dysfunction.Results:The age,gender,weight,preoperative complications(hypertension,diabetes)in two groups showed no statistical significance;there were no statistical significance in brachiocephalic truck,left subclavian artery,left common carotid artery,intercostals arteries,celiac trunk,superior mesenteric artery,renal artery,iliac artery involved by aortic dissection;similarly,there were no obvious differences in operating time,cardiopulmonary bypass time,aortic cross-clamp time,circulatory arrest time,recovery time.The cooling time,rewarming time in 28℃ group were remarkably shorter than that in 25℃ group after analysis.In 28℃group,it showed lower incidence of postoperative body sensory and motor abnormalities,less severe symptoms,shorter recovery time andbetter outcomes than those in 25℃ group.The postoperative CT showed that blood flowing in artificial ascending aorta,aortic arch and place of the stent was more fluent.The true lumens expanded significantly to normal and the false lumens shrank to approximately disappear.The incidence of other complications such as brain stroke,renal insufficiency,death and etc in 25℃ group was higher than that in 28℃ group except spinal cord injury.Conclusion:During hypothemic circulatory arrest of the Debakey typeⅠ aortic dissection surgery,comparing with the deep hypothermia(20~25℃),the moderate hypothermia(25~28℃)had lower incidence of postoperative body sensory and motor abnormalities,less severe symptoms,shorter recovery time and better outcomes.Moderate hypothemia might be a more effective measure at the aspect of spinal cord protection.