成人主动脉缩窄合并心脏疾病的一期外科治疗  

One-stage repair for aduIts aortic coarctation concomitant with cardiac diseases： ascending aorta-abdominal aorta by-pass combined with cardiac operation

作　　者：葛翼鹏[1] 里程楠[1] 杨祎[1] 洪建茂 程鹏 朱帅[1] 郑军[1] 刘永民[1] 朱俊明[1] 孙立忠[1] Ge Yipeng;Li Chengnan;Yang Yi;Hong Jianmao;Cheng Peng;Zhu Shuai;Zheng Jun;Liu Yongmin;Zhu Junming;Sun Lizhong(Department of Cardiovascular Surgery,Beijing Aortic Disease Center,Beijing Anzhen Hospital,Capital Medical University,Bei- ring 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心血管外科北京心血管疾病中心,100029

出　　处：《中华胸心血管外科杂志》2018年第7期403-405,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京市科技重大项目（E171100001017083）

摘　　要：目的探讨成人主动脉缩窄合并心脏疾病的一期外科矫治方法及效果。方法2009年2月至2016年9月，24例成人主动脉缩窄合并心脏疾病的患者接受一期外科手术治疗。所有患者均在纠正心脏疾病的同时行升主动脉一腹主动脉转流术。其中2例冠心病合并主动脉缩窄患者在非体外循环下行一期矫治，22例在体外循环辅助下行一期外科矫治。术前患者上、下肢平均动脉压压差为（38．00±9．34）mmHg（1mmHg=0．133kPa）。结果全组无院内死亡。术后患者上、下肢动脉血压压差为（11．44±2．59）mmHg。术中体外循环（107．27±34．56）min，主动脉阻断（72．59±28．98）min。ICU停留（35．22±50．41）h，呼吸机辅助（19．50±17．64）h。2例呼吸机辅助时间超过48h，其中1例因呼吸功能衰竭行ECMO辅助。1例因急性肾功能不全行临时肾脏替代治疗。术后无二次开胸止血，无肠道并发症。所有患者术后均行主动脉CTA复查，人工血管均通畅，无人工血管相关并发症发生。结论升主动脉一腹主动脉转流同时行心脏疾病矫治一期手术治疗成人主动脉缩窄合并心脏疾病安全、有效。Objective Evaluate the surgical result of ascending aorta-abdominal aorta bypass combined with cardiac operation for adults aortic coarctation concomitant with cardiac diseases. Methods Between February 2009 and September 2012, total 24 consecutive patients underwent ascending aorta- abdominal aorta bypass combined with cardiac operation. Of these patients, 2 patients who underwent off-pump coronary artery bypass grafting combined with ascending aorta-abdominal aorta by- pass did not required cardiopulmonary bypass. Other 22 patients underwent one stage repair under cardiopulmonary bypass. The mean artery pressure of upper-lower limb was （ 38.0 ± 9.34） mmHg. Results There was no in-hospital mortality. The mean artery pressure of upper-lower limb was（ 11.44±2.59） mmHg. The mean cardiopulmonary bypass time was（ 107.27± 34.56） min. The mean aorta clamp time was（72.59±28.98）min. The mean intensive care unit stay time is（35.22 ± 50.41 ）h. The mean mechanical ventilation time was（ 19.50 ± 17.64）h. 2 patients required prolonged mechanical ventilation for respiratory dysfunction. Of these 2 patients, 1 patient required ECMO support for respiratory failure. Total 1 patient needed temporary continuous renal replacement therapy. No re-exploration for bleeding and gastrointestinal complications were ob- served. Aorta CTA scan was performed for aU patients before discharged from hospital. The grafts were patent for all patients and no graft-related complications were observed. Conclusion Ascending aorta-abdominal aorta bypass combined with cardiac operation is a safe and effective one stage repair technique for adults aortic coarctation concomitant with cardiac diseases is a safe and effective technique.

关 键 词：主动脉缩窄 升主动脉-腹主动脉转流 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]