不同腋动脉插管方法在StanfordA型主动脉夹层手术中的应用  

Comparison of Two Right Axillary Artery Perfusion Methods for Stanford Type A Aortic Dissection

作　　者：贾在申[1] 张慧萍[2] 许卫民[2] 侯晓彤[1] 

机构地区：[1]首都医科大学附属北京安贞医院体外循环科,北京100029 [2]解放军第452医院麻醉科,成都610021

出　　处：《中国胸心血管外科临床杂志》2012年第1期26-30,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的比较两种不同右侧腋动脉插管方法对Stanford A型主动脉夹层患者行主动脉弓置换术的安全性和临床效果。方法 2008年7月至2010年7月北京安贞医院对280例Stanford A型主动脉夹层患者采用右侧腋动脉插管建立体外循环(CPB),行全弓置换+降主动脉支架人工血管植入术。根据术中腋动脉插管方式将280例患者分为两组,直接插管组(n=215),年龄(43.1±9.5)岁,行直接腋动脉插管;间接插管组(n=65),年龄(44.7±8.3)岁,腋动脉连接人工血管行间接插管。观察两组患者的安全性,比较相关手术参数、临床结果和术后恢复情况。结果住院死亡10例,其中直接插管组7例(7/215,3.3%),间接插管组3例(3/65,4.6%);所有患者均成功行腋动脉插管;术后25例(25/280,8.9%)出现暂时性神经系统功能障碍,其中直接插管组19例(8.8%),间接插管组6例(9.2%),均经治疗痊愈。间接插管组患者术后腋动脉插管并发症明显少于直接插管组,差异有统计学意义((1例vs.19例,P=0.045)。两组患者体外循环期间最高流量、最高泵压,深低温停循环时间、顺行性脑灌注时间和CPB时间差异均无统计学意义(P>0.05)。结论经人工血管右侧腋动脉插管可以降低腋动脉插管相关并发症,安全用于Stanford A型主动脉夹层患者的外科手术治疗。Objective To evaluate the clinical safety and neurological outcomes of right axillary artery cannulation with a side graft compared with a direct approachin aortic arch replacement for patients with acute Stanford type A aortic dissection.Methods Between July 2008 and July 2010,280 consecutive patients with acute Stanford type A aortic dissection underwent right axillary artery cannulation for cardiopulmonary bypass（CPB）in total arch replacement and stented ＂elephant trunk＂ implantation in our hospital.These 280 patients were divided into two groups according to the method of axillary artery cannulation in operation：direct arterial cannulation was used in 215 patients（direct arterial cannulation group,DG group,mean age of 43.1±9.5 years）,while cannulation with a side graft was used in 65 patients（indirect cannulation group,IG group,mean age of 44.7±8.3 years）.Clinical characteristics of both groups were similar except their axillary artery cannulation method.Patient outcomes were compared as to the prevalence of clinical complications,especially neurological deficits and postoperative morbidity.Results The overall hospital mortality was 3.6%（10/280）,3.3%（7/215）in DG group and 4.6%（3/65）in IG group respectively.Right axillary artery cannulation was successfully performed in all cases without any occurrence of malperfusion.Postoperatively,25 patients（8.9%）developed temporary neurological deficits,19 cases in DG group（8.8%）,and 6 cases in IG group（9.2%）,and all these patients were cured after treatment.The incidence of postoperative complications directly related to axillary artery cannulation was significantly lower in IG group than that in DG group（1 case vs.19 cases,P=0.045）.There were no statistical differences in arterial perfusion peak flow,peak pressure,antegrade cerebral perfusion time,deep hypothermic circulatory arrest time,and CPB time between the two groups（P 0.05）.Conclusion Right axillary artery cannulation with a side graftcan significantly reduce th

关 键 词：主动脉夹层 深低温停循环 顺行性脑灌注 腋动脉插管 

分 类 号：R654.3[医药卫生—外科学]