<原著論文>胸部大血管手術と脳保護〜選択的脳潅流,周術期管理と術後中枢神経障害の発生〜

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Background: We reviewed our experiences in order to analyze thefactors causing central neurological dysfunction in thoracic aortic arch surgeries withantegrade selective cerebral perfusion (ASCP).Methods: Between October 2000 and September 2003, 76 patients underwent thoracicaortic surgery with ASCP, comprising 55 men (72.4%) and 21 women (27.6%),ranging in age from 27 to 86 years (mean 67.8 ± 10.9 years). Thoracic aortic lesionswere identified as aneurysms in 43 patients (56_6%) and dissections in 33 patients(43.4%). Perioperative factors were analyzed by univariate and multivariate analyse toidentify predictors of transient neurological dysfunction (TND).Results: Permanent neurological dysfunction (PND) occurred in two patients(2.6%), as a result of embolism during surgery, and TND in 15 patients (19.7%).Univariate logistic regression indicated that ruptured aneurysm, hypertension, preoperativemean blood pressure, history of neurological disease, and operation time had asignificant influence on the indication of TND. Multivariate analysis revealed thatruptured aneurysm, history of neurological disease and operation time were statisticallysignificant predictors of TND.Conclusions: It is suggested that cerebral autoregulation may influence the outcomeof TND, and precise blood pressure control might be an important factor formaintaing cerebral perfusion.
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