PDF(Pubmed)
Abstract：
Background and objectives: The relationship between cerebral perfusion and new postoperative ischemic stroke in obese patients is not well defined. The aim of this study was to investigate the association between selective bilateral anterograde cerebral perfusion and new postoperative ischemic stroke in obese patients with emergency surgery for acute type A aortic dissection. Materials and methods: A total of 292 patients with emergency surgery for acute type A aortic dissection were included in this study. Patients with hemorrhagic stroke or ischemic stroke with severe neurological dysfunction at admission that were not candidates for surgery; patients who died in the first 48 h after intensive care admission and patients with incomplete medical records were excluded. Results: The mean age was 59.42 ± 10.68 years and the mean Euroscore was 9.12 ± 1.63. Obesity was present in 76.4%, the incidence of new postoperative ischemic stroke was 27.5%, and the postoperative mortality rate was 26.7%. The mean cardiopulmonary bypass time was 206.81 ± 75.48 min, the aortic cross-clamp time was 118.2 ± 46.42 min, and 90% of cases required cerebral perfusion. The mean cerebral perfusion time was 30.8 ± 24.41 min. Obese patients had a higher frequency of in-hospital death (p = 0.009), smoking (p = 0.036), hypertension (p = 0.023), left common carotid artery dissection (p < 0.001), right common carotid artery dissection (p = 0.029), femoral artery cannulation (p = 0.026), aortic root replacement (p = 0.009), aortic valve replacement (p = 0.005) and early reintervention for bleeding (p = 0.004). Using logistic regression, selective bilateral anterograde cerebral perfusion over 40 min in obese patients was independently associated with new postoperative ischemic stroke (OR = 2.35; 95%CI = 1.36-4.86; p = 0.021). Conclusions: A patient-tailored strategy for cerebral perfusion should be considered in obese patients, considering the high atheromatous burden of the supra-aortic vessels in these patients and the potential risk of atheromatous embolization associated with this technique.
摘要：
背景与目的：肥胖患者脑灌注与术后新发缺血性卒中之间的关系尚不明确。这项研究的目的是研究在急性A型主动脉夹层急诊手术的肥胖患者中，选择性双侧顺行脑灌注与新的术后缺血性卒中之间的关系。材料和方法：本研究共纳入292例急性A型主动脉夹层急诊手术患者。入院时出现严重神经功能障碍的出血性卒中或缺血性卒中患者不适合进行手术；重症监护入院后前48小时死亡的患者和病历不全的患者被排除在外。结果：平均年龄为59.42±10.68岁，平均Euroscore为9.12±1.63。肥胖占76.4%，术后新发缺血性卒中的发生率为27.5%,术后死亡率为26.7%。平均体外循环时间为206.81±75.48min,主动脉阻断时间118.2±46.42min,90%的病例需要脑灌注。平均脑灌注时间为30.8±24.41分钟。肥胖患者住院死亡的频率更高（p=0.009），吸烟（p=0.036），高血压（p=0.023），左颈总动脉夹层（p<0.001），右颈总动脉夹层（p=0.029），股动脉插管（p=0.026），主动脉根部置换（p=0.009），主动脉瓣置换术（p=0.005）和出血的早期再干预（p=0.004）。使用逻辑回归，在肥胖患者中,超过40分钟的选择性双侧顺行脑灌注与新的术后缺血性卒中独立相关(OR=2.35;95CI=1.36-4.86;p=0.021).结论：肥胖患者应考虑针对患者量身定制的脑灌注策略，考虑到这些患者主动脉上血管的高动脉粥样化负担以及与该技术相关的动脉粥样化栓塞的潜在风险。
