摘要
目的:探讨主动脉夹层深低温停循环术(deep hypot-hermic circulatory arrest,DHCA)后出现高钠血症的原因。方法:51例主动脉夹层患者均在DHCA下手术,对18例术后出现高钠血症的患者(高钠组)和同期术后血钠正常的33例患者(对照组)的临床资料作回顾性分析,并对两组患者手术前后峰值血钠(Na+)、空腹血糖(GLU)、剩余碱(BE)、血乳酸含量(Lac)、Scr,术前左心室射血分数(LVEF),术中体外循环(CPB)时间、主动脉阻断时间、停循环时间,术后甘露醇日平均剂量、神经系统症状、机械通气时间、ICU停留时间、APACHE II评分及相关资料进行比较。结果:高钠组Stanford A型比例及术后神经功能障碍发生率均为88.9%,术后呼吸机辅助时间、ICU停留时间、Lac、甘露醇日平均剂量分别为(102.47±53.62)h、(6.82±2.48)d、4.40(2.15,8.75)mmol/L及(50.77±28.33)g/d,明显高于对照组(P<0.01);高钠组CPB时间、主动脉阻断时间、术后GLU、APACHE II评分分别为(213.44±56.22)min、(121.39±38.23)min、(14.31±5.77)mmol/L及(18.15±6.66)分,均高于对照组(P<0.05);高钠组术后BE、Scr、停循环时间分别为(-1.03±4.49)mmol/L、(61.67±17.17)μmol/L及(46.17±14.13)min,与对照组比较差异无统计学意义(P>0.05)。结论:主动脉夹层DHCA术后高钠血症原因与病变复杂、体外循环及主动脉阻断时间长、术后高血糖、乳酸酸中毒、并发神经系统损伤及甘露醇日平均用量过大有关。高钠血症可导致细胞脱水加重病情,应及时给予纠正。
Objective：To analyze the cause for hypernatremia in patients after aortic dissection surgery under deep hypothermie circulatory arrest（DHCA）. Methods ：51 cases underwent aortic dissection surgery un- der DHCA were retrospectively analyzed. The clinic indexs were compared between observational group with hy- pernatremia （n = 18 ） and control group with normal sodium concentration（ n --33 ）. General conditions, serum sodium and plasma glucose level （GLU）, base excess （BE）, blood lactate concentration（ Lac）, Scr, left ven- tricular ejection fraction（LVEF） , the duration of cardiopulmonary bypass（ CPB ） and aorta block, mechanical ventilation and ICU monitoring time, neurological complications, mannitol average daily dose, APACHE II score were record in perioperative period. Results：In hypernatremia group, the ratio of A type aortic dissection and neurological dysfunction were 88.9% respectively. Ventilation time, ICU monitoring time, Lac, mannitol aver- age daily dose were （ 102.47 ± 53.62 ） h, （ 6. 82 ± 2.48 ） d,4.40 （ 2. 15,8. 75 ） mmol/L, （ 50. 77 ± 28.33 ） g/d respectively. Compared with control group, all above comparisons showed significant difference （P 〈 0. 01 ）. In hypernatremia group, the duration of CPB and aorta block were （213.44 ± 56. 22 ）min and （121.39 ± 38. 23 ）min, GLU and APACHE II score postopration were（ 14. 31 ± 5.77）mmol/L and （18. 15 ＋ 6. 66）scores, which were higher than those in control group （ P 〈 0. 05 ）. BE, Scr and deep hypothermic circulatory arrest time be- tween the two groups had no significant difference （P 〉 0.05 ）. Conclusion：The cause for hypernatremia in pa- tients after aortic dissection surgery under DHCA were connected with A type aortic dissection, longer CPB and aortic clump time, hyperglycemia,lactic acidosis, neurological complications postopration and high-dose manni- to1. Hypernatremia can lead to cell dehydration and aggravate the case＇ s condition, which should be corrected timely.
出处
《心肺血管病杂志》
CAS
2013年第5期594-597,共4页
Journal of Cardiovascular and Pulmonary Diseases
关键词
高钠血症
主动脉夹层
深低温停循环
电解质紊乱
Hypernatremia
Aortic dissection
Deep hypothermic circulatory arrest
Electrolyte dis-turbance
