Stanford A型主动脉夹层急诊行外科手术治疗的临床探讨  

Clinical study of the patients with Stanford type A aortic dissection received urgent surgery

作　　者：张明明[1] 伊力哈木江·克尤木[1] 吴元元[1] 木拉提·阿布都热合曼[1] 李俊红[1] 

机构地区：[1]新疆医科大学第一附属医院心脏中心心脏外科一科,乌鲁木齐830054

出　　处：《中华急诊医学杂志》2016年第1期79-82,共4页Chinese Journal of Emergency Medicine

摘　　要：目的分析主动脉夹层（Stanford A型）患者急诊行外科手术治疗死亡的相关危险因素，以期对临床进一步参考。方法回顾性分析新疆医科大学第一附属医院自2009年1月至2015年6月197例主动脉夹层（Stanford A型）并急诊行外科手术患者的临床资料，分别对术前、术中相关资料进行统计分析，从而筛选出易致早期死亡的危险因素。结果本组197例患者死亡23例，病死率为11．68％。通过单因素分析结果显示：既往有高血压病史、冠心病病史、二次开胸止血、左室射血分数≤50％，转运时间≥180min，阻断时间≥120min，肌酐≥130μmol／L，差异具有统计学意义。通过多因素Logistic回归分析结果提示：患者术前肾功能衰竭（肌酐≥130μmol／L），术中阻断时间≥120min与术后早期死亡高度相关。结论主动脉夹层患者手术风险很大，术前需全面评估患者全身情况及各项指标，术中操作温柔仔细迅速，缩短术中阻断时间，尽早完成手术，围手术期积极采取各项措施，提高外科手术治疗的安全，降低早期患者死亡风险，改善患者预后。Objective To analyse the factors influencing the death of patients with aortic dissection （ Stanford type A arota dissection） who underwent urgent surgery. Methods The clinical data of 197 patients with aortic dissection （Stanford type A arota dissection） treated with urgent surgery from the First Affiliate Hosiptal of Xinjiang Medical University were retrospectively analyzed between January 2009 and June 2015 in order to determine the factors influencing the early-mortality. Results Of them, 23 patietns dead. In univariant analysis, the rate of mortality was 11.68%. The following factors at admission were independetly associated with early-mortality： hypertension, coronary atherosclerotic heart disease, LVEF ≤ 50%, time consumed for CPB ≥ 180 rain, time required for cross-clamping aorta ≥120 min, Cr ≥ 130μmol/L, rethoracotomy for hemostasis （P 〈 0.05 ）. The preoperative renal failure （Cr ≥ 130 μmol/L） and time consumed for cross-clamping aorta ≥ 120 min were strongly associated with the early-mortality based on the logistic regression analyses. Conclusions The risk of aortic dissection surgery is very high, and it is mondatory to carefully evaluate the patient＇ s general condition and the indications during peroperative period, and to take active measures to shorten the time of clamping aorta and total operation time in order to reduce the risk of operation and increase the survival rate of patients.

关 键 词：主动脉夹层 外科手术 危险因素 

分 类 号：R543.1[医药卫生—心血管疾病]