Comparative Analysis Of Bilateral Cerebral Perfusion Brain Protection At Different Temperatures During Aortic Arch Replacement

Objective:To compare and analyze the effects of different temperatures on the cerebral protection of Improved Elephant Trunk Aortic Arch Replacement with bilateral selective cerebral perfusion(USCP),and to explore the situation of postoperative neurological complications and the prognosis,as well as the recovery of other organ damage,in order to optimize the suitable temperature for circulatory arrest.Method:Retrospective analyzed the 94 patients with TAAD(including IMH)and AA,be operated with Cerebral Protection by USCP in Improved Elephant Trunk Aortic Arch Replacement,which come from the Qilu Hospital Cardiac Surgery Department,and operation time was from January 2017 to April 2018.The patients were aged 16-77 years old,including 75 males and 19 females with an average age of 51 ± 10.86 years.According to the nasopharyngeal temperature of the patients during the operation,the patients were divided into 64 cases of type A 26 0C and 30 cases of type B 28 ?.Analysis of preoperative comorbidities,surgical approaches,cardiopulmonary bypass time(CPB),aortic blocking time,stop cycle time,postoperative recovery time,tracheal intubation(use of ventilator)time,the incidence of neurological dysfunction complications(including the number of TND?PND cases),intraoperative blood product dosage(erythrocytes,plasma,cryoprecipitate,platelets),cooling and rewarming efficiency and prognosis outcomes data,Student t test and chi-square test were used for statistical analysis.We will comparative analysis the differences of the Improved Elephant Trunk Aortic Arch Replacement under USCP,like postoperative neurological dysfunction and other organ injury recovery.And analyze the relationship between preoperative and intraoperative data and postoperative neurological dysfunctionResult:There were 13 cases of TND and 8 cases of PND in group A;there were 1 case of TND and 9 cases of PND in group B.The incidence of postoperative TND was higher in group A and the incidence of postoperative PND was higher in group B,chi-square test is P<0.05;the total rewarming time was different in the two groups?105.27±22.66(min)in group A and 91.27± 18.38(min)in group B.The average time of group A was longer than group B.The amount of cryoprecipitate used in operation was different,group A was 10.45 ± 8.24(U),group B was 14.53 ± 10.74(U),the average dose of group A was less than group B,t test result is P<0.05;it's statistically significant difference between the data of each group.Conclusion:To compare the effects of 26 ? and 28 ? in the Improved Elephant Trunk Aortic Arch Replacement,and the USCP was used as a brain protection.The incidence of TND was higher in the 26 ? group than in the 28 ? group,and the incidence of PND was lower.The risk of permanent injury was greater,the 26 ?group is better and safer than the 28 ? group for brain protection.The 26 ?group is better than the 28 ? group for intraoperative hemostasis,saving the use of cold precipitation and making it more economical.The 26 ? group is longer than the total rewarming time at the 28 ? group,which increases the duration of intraoperative hypothermia on the body.There was no significant difference between 26 ? and 28 ?in postoperative prognosis,lung function recovery,urinary,digestive,and respiratory complications.