右腋动脉直径分组标准在Stanford A型主动脉夹层手术中的应用  

The application of grouping criteria of right axillary artery for patients with acute Stanford type A aortic dissection

作　　者：齐胤尊 马云鹏[1] 赵文杰 周文军[1] 朱双雄 QI Yin-zun;MA Yun-peng;ZHAO Wen-fie(Department of Cardiovascular Surgery,the First Hospital of Tianshui ,Tianshui 741000,China)

机构地区：[1]天水市第一人民医院心血管外科

出　　处：《中国心血管病研究》2018年第12期1123-1126,共4页Chinese Journal of Cardiovascular Research

摘　　要：目的总结右腋动脉(RAA)直径分组标准在StanfordA型主动脉夹层手术中的应用经验,探讨如何依据此分组标准更合理地选择右腋动脉插管(RAAC)方法。方法选择2015年3月至2017年12月48例在我院心血管外科行孙氏手术的急性StanfordA型主动脉夹层患者为研究对象,术前在主动脉CTA上测量每例患者的RAA直径,制订RAA直径分组标准,RAA直径≤6mm者为A组,≥10mm者为B组.7-9mm者为C组。依据患者RAA直径的不同组别,RAAC选择“荷包法”(PM)或“横切法”(CM)。分析RAAC并发症的原因,总结RAA直径分组标准在RAAC中的应用经验。结果入选病例中RAA直径A组16例(33.3%),B组10例(20.8%),C组22例(45.8%)。A组RAAC均采用CM,体外循环(CPB)均采用RAAC—FAC策略;B组RAAC采用PM的插管成功率为90%(9/10),CPB均采用RAAC策略;C组RAAC采用PM的插管成功率为45.5%(10/22),CPB采用RAAC策略的比例为36.4%(8/22),采用RAAC—FAC策略的比例为63.6%(14/22)。C组的RAAC并发症的发生率最高(9/22,40.9%),其中PM所致的RAAC并发症8例(8/22,36.4%)。结论RAA直径A组者,RAAC直接采用CM;RAA直径B组者,RAAC优先采用PM;RAA动脉直径C组者,RAAC优先采用CM,CPB选择RAAC-FAC策略更为稳妥。Objective To summarize the experience of grouping criteria of right axillary artery (RAA)for patients with acute Stanford type A aortic dissection,and to explore how to select more appropriate method of right axillary artery cannulation (RAAC)according to the grouping criteria.Methods The group with the diameter≤6mm was group A,the group with the diameter≥10mm was group B,and the group with the diameter between 7 and 9mm was group C.48cases with acute type A aortic dissection were enrolled in the research,who underwent Sun's procedure in our hospital.Each case was divided into the corresponding group of RAA diameter measured with the preoperative aorta CTA.According to the different groups of RAA diameter,RAAC selected pockets method (PM)or crosscutting method (CM).The causes of RAAC complications were analyzed and the application of RAA diameter grouping standard in RAAC was summarized.Results There were 16cases (33.3%) in group A,10cases (20.8%)in group B and 22cases (45.8%)in group C.In group A,CM was applied to RAAC directly,and cardiopulmonary bypass (CPB)selected strategy of RAAC-FAC without exception.In group B,PM was applied to RAAC with a 90%(9/10)success rate,and CPB selected strategy of RAAC equally.In group C,PM was applied to RAAC with a 45.5%(10/22)success rate,and CPB selected strategy of RAAC for 36.4%(8/22),strategy of RAAC-FAC for 63.6%(14/22).There was the highest incidence rate of complications of RAAC (9/22,40.9%)in group C,which was induced by PM in 8cases (8/22,36.4%).Conclusion CM should be applied to RAAC directly for the cases with the RAA diameter6mm.PM should be applied to RAAC in priority for the cases with the RAA diameter≥10ram.RAAC with using CM will be the priorityfor the cases with the RAA diameter≥7-9ram,and it is much better to select strategy of RAAC-FAC for CPB.

关 键 词：主动脉夹层 体外循环 动脉插管 右腋动脉 孙氏手术 

分 类 号：R654.2[医药卫生—外科学]