Analysis Of The Risk Factors Of Neurological Complications In Patients After Type A Aortic Dissection Surgery

Background and objectiveAortic dissection(AD)refers to that blood flow in the tear layer because of the tearing of intima and the rupture of media in aortic wall because of various internal and external pathogenic factors.The aortic lumen is divided into double-lumen aorta by the stripping of the intima and part of the rupture media.Aortic dissection can be divided into type A and type B according by Stanford classification.Type A involves ascending aorta,wherever the tearing and involvement are,and type B involve descending aortas beyond of the left subclavian artery opening.The hemodynamics of Type A aortic dissection is extremely unstable,the progress is more quick,the condition is more dangerous and the mortality is higher,so it is fatal.If AD occurs within the ascending aorta,40% of patients die immediately and mortality is 1%–2% for each hour afterwards resulting in a 48-hour mortality of approximately 50%.At present,the surgical treatment of TAAD is still the preferred treatment.Because of its wide range of lesions,involving more important organs,the difficulty of the surgery,perioperative mortality and postoperative complications are still high.Neurological dysfunction is a common complication after the cardiovascular surgery,especially involving the aortic arch in surgery,because of the maximum of oxygen consumption of the brain tissue,the minimum of oxygen reserves and the low tolerance of hypoxia.So it becomes the vulnerable organ during the cardiopulmonary bypass open heart surgery.Thus neurological dysfunction after the cardiopulmonary surgery began to get the attentions of the clinicians from 1960 s.After the development of cardiopulmonary bypass machine,surgical techniques and devices,and the use of brain protection,the incidence is still high.Neurological dysfunction is still an important issue affecting the surgical results,especially in the surgery of aortic dissection and others which needs deep hypothermic circulatory arrest.How to reduce the incidence of neurological complications after TAAD surgery is of great significance to the prognosis of TAAD patients.In this paper,we analyzed the data of TAAD patients from January 2014 to September 2016 in the Second Affiliated Hospital of Zhengzhou University,found that the related risk factors of neurological system after TAAD and aimed to reduce the incidence.Materials and methodsThe data of 66 patients after Type A aortic dissection surgery from January 2014 to September 2016 were collected,divided into two groups according to the presence or absence of nervous system diseases and analyzed by the single factor and multiple factors logistic regression analysis.ResultsThe incidence rate of neurological complications in patients after Type A aortic dissection surgery was 39.4%(26/66),in which transient neurological dysfunction was 33.3%(22/66)and permanent neurological dysfunction was 6.1%(4/66).2.Single factors logistic regression analysis showed that hypertension,hydropericardium,operation time,cardiopulmonary bypass time,aortic cross-clamp time,ventilator assisted breathing and ICU stay time were the related risk factors of neurological complications in patients after Type A aortic dissection surgery.3.Multiple factors logistic regression analysis showed that Cardiopulmonary bypass time and ICU stay time were the independent risk factors of neurological complications in patients after Type A aortic dissection surgery.Conclusion1.Hypertension,hydropericardium,operation time,cardiopulmonary bypass time,aortic cross-clamp time,ventilator assisted breathing and ICU stay time are the related risk factors of nervous system diseases in patients after Type A aortic dissection surgery.2.Cardiopulmonary bypass time and ICU stay time is the independent risk factors of nervous system diseases in patients after Type A aortic dissection surgery.