Analysis of risk factors of postoperative cerebral neurological complications in patients undergoing aortic arch surgery

doi:10.3969/j.issn.1672-5301.2017.06.009

Abstract：Objective To explore the risk factors and optional treatment strategies for postoperative cerebral neurological complications in patients undergoing aortic arch surgery.Methods From June 2014 to March 2016,216 patients received Stanford A aortic dissection surgery.Of them,139 men and 77 women,age (46.8±11.1)years old.All patients received surgery under deep hypothermic circulatory arrest(DHCA) and general anesthesia.All patients were admission to ICU for standard of care therapy after surgery.They were grouped by postoperative cerebral neurological complications.Cerebral neurological complications included permanent neurological dysfunction and temporary neurological dysfunction.Analysis of possible related factors and aggressive treatment strategies took place immediately after cerebral neurological complications was diagnosed.Comparison analysis was performed between complications groups and non-complications groups in length of mechanical ventilation,length of ICU stay,length of hospital stay,rate of reintubation and mortality.Results Postoperative neurological complications was observed in 61 cases(28.2％).PND was observed in 8 cases(3.7％),TND was observed in 53 cases (24.5％).In-hospital mortality was 7.87％(17/216),10 with neurological complications and 5 without neurological complications.Comparison analysis between neurological complications group and non-neurological complications group in length of mechanical ventilation,length of ICU stay,length of hospital stay,rate of reintubation and mortality were with statistical differences.Univariate analysis showed the associated factors were age,hypertension,stroke history,nervous system symptoms history,emergency surgery,intraoperative circulation situation,intraoperative glucose level,aorta clamping time,deep hypothermic circulatory arrest time and blood transfusion,postoperative hypoxemia,renal dysfunction,postoperative low cardiac output and postoperation acute infection.Multivariate analysis showed the independent predictive factors were DHCA time＞40 min,intraoperative mean arterial pressure fluctuations＞30 mm Hg,blood transfusion＞1 L,renal dysfunction and postoperative low cardiac output.Conclusion In our experience,factors independently associated with neurological complications are long DHCA time,large fluctuations in mean arterial pressure,massive blood transfusion,renal dysfunction and postoperative low cardiac output.