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急性A型大动脉剖析治疗中的温度管理:深度或中度低温循环停止. 寒冷有没有更好?

Hend Abdulwahab Muftah Abdulwahab¹, Alish Kolashov², Assad Haneya²

¹Department of Transfusion Medicine, Faculty of Medicine, RWTH University Hospital Aachen, RWTH Aachen University, Aachen, Germany.

Frontiers in cardiovascular medicine

|November 11, 2024

概括

深度低温循环停止 (DHCA) 增加了A型大动脉剖析修复后急性损伤和妄想的风险. 中度低温循环停止 (MHCA) 是一个更安全的替代方案,减少并发症和重症监护室停留.

科学领域:

心血管外科心血管外科
胸部外科手术胸部外科手术
大动脉外科手术

背景情况:

在A型大动脉解剖 (TAAD) 修复过程中,低温的最佳程度受到争议.
使用深度低温循环停止 (DHCA) 和中度低温循环停止 (MHCA),每个都有潜在的好处和风险.

研究的目的:

为了比较TAAD患者用DHCA (<20°C) 与MHCA (20-28°C) 治疗的临床结果.

主要方法:

对143名TAAD患者进行了回顾性分析,这些患者接受了手术修复,血液循环停止和单边前级选择性脑输液 (uSCP).
患者被分为DHCA (n=103) 和MHCA (n=40) 组.
主要结局:主要事件 (CMEs) 的组合,包括狂妄症,急性损伤 (AKI) 和住院死亡率. 其次性结局包括死亡率,出血,回切除术和ICU停留.

主要成果:

在DHCA组显示显著更高的术后AKI (25.2%对7.5%),妄 (22.3%对5%) 和重新探索 (20.4%对5%).
DHCA与更长的心肺绕道和交叉时间以及更长的ICU停留时间有关.
MHCA证明了对术后妄和AKI的保护作用,调整后的几率比分分别为0.28和0.29. 两年生存率在各组之间没有差异.

结论:

DHCA与术后AKI和痴呆症的风险增加有关,导致长时间住院治疗.
当TAAD修复在临床上可行时,由于并发症率较低,应该优先选择MHCA.
对于复杂的剖析病例,DHCA仍然是一个可行的选择.

关键词:

急性类型是一大动脉剖析.大动脉外科手术深度低温低温的情况低温性循环停止血液循环停止中等程度的低温症.

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