88例Stanford A型主动脉夹层外科治疗效果  

Results of the surgical treatment in 88 cases with Stanford type A aortic dissection

作　　者：吴玉辉[1,2] 江蕊[3] 江磊[1] 潘玉柱[1] 于仁斌[1] 王涛[1] 杨林山[1] 常青[1] 

机构地区：[1]青岛大学附属医院心血管外科,山东青岛266003 [2]青岛大学附属心血管病医院,山东青岛266106 [3]青岛大学附属医院手术室,山东青岛266003

出　　处：《临床军医杂志》2017年第11期1149-1152,共4页Clinical Journal of Medical Officers

摘　　要：目的探讨Stanford A型主动脉夹层患者手术治疗效果。方法回顾性分析自2011年1月至2016年3月青岛大学附属医院收治的88例Stanford A型主动脉夹层患者临床资料,分析患者术前、体外循环、围术期输血量、机械通气时间、ICU住院时间、总住院时间及术后并发症等相关资料。结果行非全弓置换术16例为非全弓置换术组,其中,单纯升主动脉置换术7例,单纯Bentall手术9例;行全弓置换术72例为全弓置换术组,其中,升主动脉置换+孙氏手术40例,Bentall手术+孙氏手术31例,David手术+孙氏手术1例。与非全弓置换术组比较,全弓置换术组患者术中鼻咽温及肛温低,体外循环及升主动脉阻断时间长,术中红细胞、血浆及血小板输血量大,术后呼吸机通气时间及ICU住院时间长,引流量多,术后红细胞、血浆、血小板输注量大,神经系统并发症发生率高,差异均有统计学意义(P<0.05)。患者自体输血量,总住院时间,术后急性肾损伤、低氧血症、连续肾替代疗法应用、二次气管插管、气管切开情况及病死率方面,全弓置换术组高于非全弓置换术组,但差异无统计学意义(P>0.05)。术后随访,非全弓置换术组2例(12.5%)患者因主动脉弓部夹层行全弓置换术+降主动脉支架植入术,全弓置换术组无行二次手术者,差异有统计学意义(P<0.05)。结论 Stanford A型主动脉夹层患者病变复杂,病情重,手术风险大,病死率高,但手术治疗效果满意;术中脑保护尤为重要,选择手术方式应综合考虑。Objective To investigate the results of the surgical treatment in the patients with Stanford type A aortic dissection.Methods Aretrospective study was performed on 88 cases of patients who were admitted and underwent surgery of the Stanford type A aortic dissection from January 2011 to March 2016.The preoperative data,in vitro circulation data,perioperative blood transfusion volume,mechanical ventilation time,ICU hospitalization time,total hospitalization time and postoperative complications were analyzed.Results In the total 88 cases,16 cases were operated by the means of the none-total arch replacement without the deep hypothermic circulatory arrest（7 cases with the ascending aorta replacement and Bentall surgery in 9 cases）,and the rest of the 72 cases were operated by the total arch replacement（ascending aorta replacement ＋ Sun＇s surgery in 40 cases,Bentall ＋ Sun＇s surgery in 31 cases,David＋ Sun＇s surgery in 1 case）.Compared with the patients of non-total arch replacement group,patients of total arch replacement group were with low intraoperative nasopharyngeal temperature and anal temperature,long time of extracorporeal circulation and the ascending aorta blocking,large amount of intraoperative red blood cells,plasma and platelet transfusion,long time of the breathing machine ventilation and ICU length of hospital stay,large amount of postoperative red blood cells,plasma and platelet transfusion,high incidence rate of postoperative neurological complications,and the differences were statistically significant（P〈0.05）.The autologous blood transfusion volume,the total length of hospital stay,postoperative acute kidney injury,hypoxemia,the application of continuous renal replacement therapy and secondary tracheal intubation and tracheostomy and mortality rate in the total arch replacement group were higher than those in the non-total arch replacement group,there was no statistically significant difference between the two groups（P〈0.05）.During the follow-up,2 patients（12.5%） we

关 键 词：主动脉夹层 体外循环 深低温停循环 选择性脑灌注 

分 类 号：R543.1[医药卫生—心血管疾病]