摘要
目的探讨心脏手术后早期昏迷的病因和预防措施。方法回顾性分析武汉亚洲心脏病医院2002年1月1日至2004年5月31日4358例心血管手术后早期昏迷的22例患者,研究原发疾病、外科术式、体外循环参数、水电解质平衡和血液生化等因素与昏迷发生发展的关系。结果不同手术方式术后脑损害发生率显著不同(P<0.001);术后Glasgow评分与术中平均动脉压正相关,与手术时间负相关(P<0.01);体外循环中最低血红蛋白与深昏迷时间和脑损害的总病程负相关(P<0.05);手术时间、术后Glasgow评分、血肌酐、白细胞和中性粒细胞计数对患者的预后有显著性影响(P<0.05)。结论体外循环中的动脉压下降、血液稀释和失血性贫血、涉及主动脉的手术方式和手术时间延长是心脏术后发生昏迷的高危因素。因此,提高手术技巧、缩短手术时间、减少失血、减少主动脉损伤、维持有效的脑灌注压是减少术后昏迷、改善预后的关键。
Objective To explore the causes and preventions of coma in early postoperative period of cardiovascular surgery. Methods Between January 2002 to May 2004, 22 patients with coma among 4 358 patients underwent cardiovascular surgery were reviewed with regard to the relationship between coma and primary disease, operative procedure, cardiopulmonary bypass（CPB） conditions, water-electrolyte balance, blood biochemistry, etc. Results The incidences of the coma were significant different among different operative procedures （ P 〈 0. 001 ）. The postoperative Glasgow score was significantly positively correlated with mean arterial blood pressure during extracorporeal circulation（ P 〈0. O1 ）, but was significantly negatively correlated with the time of the procedure（ P 〈0. 01 ）. The lowest hemoglobin concentration in the period of extracorporeal circulation was significantly negatively correlated with the time of deep coma or brain injury（ P 〈0.05 ）. The Glasgow score, serum creatinine, time of the procedure, WBC and neutrocyte counting were unfavorable factors for the prognosis （P 〈 O. 05 ）. Conclusions The descended arterial pressure, excessive hemodilution or hemorrhagic anemia during CPB, the procedures involved aorta artery and long-lasting operating time are high risk factors of coma after cardiovascular surgery. Therefore it is critical to sharpen operative technique, shorten the time of operating, reduce the blood loss, minimize aorta artery injury and maintain effective brain perfusing pressure in the prevention of coma during cardiovascular surgery.
出处
《中国现代手术学杂志》
2006年第5期378-380,共3页
Chinese Journal of Modern Operative Surgery
关键词
心脏外科手术
昏迷
手术后并发症
cardiac surgical procedures
coma
postoperative complications
