中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

亚低温治疗对急性 Stanford A 型主动脉夹层患者围术期炎症反应及预后影响的随机对照试验

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目的 探讨亚低温治疗对急性 Stanford A 型主动脉夹层患者围术期炎症反应、器官功能及预后的影响。方法 入选 2017 年 2 月至 2018 年 2 月收住我科的急性 Stanford A 型主动脉夹层患者 56 例,随机分为对照组及试验组,每组各 28 例。对照组患者在术中经历深低温停循环后,将体温复温至 36~37℃,并延续至术后 24 h,试验组患者体温复温至 34~35℃,余同对照组;比较两组患者预后。 结果 两组患者的临床资料差异无统计学意义。与对照组相比,在术后第 24 h,试验组外周血 MMPs 水平更低(P=0.008)。试验组患者术后的苏醒时间更短(P=0.008),血流感染的发生率更低(P=0.019),但两组患者的谵妄发生率、急性肾损伤(AKI)发生率、肝功能不全发生率、机械通气时间、住 ICU 时间及病死率差异均无统计学。两组患者术后 24 h 内的胸引量差异均无统计学意义,且均未发生寒战。 结论 亚低温治疗能够缩短急性 Stanford A 型主动脉夹层患者术后的苏醒时间,减少血流感染的发生率,且不会引起胸引量增多或寒战。

Objective To explore the therapeutic effect of mild hypothermia on the inflammatory response, organ function and outcome in perioperative patients with acute Stanford type A aortic dissection (AAAD). Methods From February 2017 to February 2018, 56 patients with AAAD admitted in our department were enrolled and randomly allocated into two groups, the control group and the experimental group. After deep hypothermia circulatory arrest during operation, in the control group (n=28), patients were rewarmed to normal body temperatures (36 to 37 centigrade degree), and which would be maintained for 24 hours after operation. While in the experimental group (n=28), the patients were rewarmed to mild hypothermia (34 to 35 centigrade degree), and the rest steps were the same to the control group. The thoracic drainage volume and the incidence of shivering at the first 24 hours after operation, inflammatory indicators and organ function during perioperation, and outcomes were compared between the two groups. Results There was no obvious difference in the basic information and operation information in patients between the two groups. Compared to the control group, at the 24th hour after operation, the levels of peripheral blood matrix metalloproteinases (MMPs) were lower in the experimental group (P=0.008). In the experimental group, after operation, the awakening time was much shorter (P=0.008), the incidence of bloodstream infection was much lower (P=0.019). While the incidence of delirium, acute kidney injury (AKI), hepatic insufficiency, mechanical ventilation duration, intensive care unit (ICU) stays, or hospital mortality rate showed no statistical difference. And at the first 24 hours after operation, there was no difference in the thoracic drainage volume between the two groups, and no patients suffered from shivering. Conclusion The mild hypothermia therapy was able to shorten the awakening time and reduce the incidence of bloodstream infection after operation in patients with AAAD, and did not cause the increase of thoracic drainage volume or shivering.

关键词: 急性 Stanford A 型主动脉夹层; 亚低温治疗; 炎症反应; 器官功能

Key words: Acute Stanford type A aortic dissection; mild hypothermia therapy; inflammatory response; organ function

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