常温动脉转流行胸腹主动脉替换术的早中期结果  

Arterial bypass with normothermia technique improves the early outcomes after extensive thoracoabdominal aorta repair

作　　者：张良 杨阳 于存涛 常谦 舒畅 孙晓刚 钱向阳 丘俊涛 王德 Zhang Liang;Yang Yang;Yu Cuntao;Chang Qian;Shu Chang;Sun Xiaogang;Qian Xiangyang;Qiu Juntao;Wang De(State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Science and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院国家心血管病中心阜外医院血管外科中心,北京100037

出　　处：《中华血管外科杂志》2018年第3期157-163,共7页Chinese Journal of Vascular Surgery

基　　金：协和重大创新项目（2016-CXGC01-2）

摘　　要：目的 探讨常温动脉转流下胸腹主动脉替换术的安全性和有效性.方法 对阜外医院血管外科中心2005年1月至2017年6月收治的符合入组标准及排除标准的190例广泛胸腹主动脉瘤患者行全胸腹主动脉置换术.患者分为两组：常温动脉转流组（A组,75例）及深低温停循环组（B组,115例）,比较分析两组患者术后早期死亡和复合并发症率以及中期生存率.结果 A组术后早期死亡1例（1.3％）,B组9例（7.8％）,两组比较差异有统计学意义（P=0.045）.复合并发症率A组11例（14.7％）,B组28例（24.3％）,两组比较差异无统计学意义（P=0.075）;持续神经损伤A组5例（6.7％）,B组19例（16.7％）,两组比较差异有统计学意义（P=0.044）.多因素分析显示：持续性神经损伤（OR：13.50,95％CI：3.48～52.36,P=0.000）,深低温停循环（OR：15.85,95％CI：2.64～95.13,P=0.003）,新发肾功能不全（OR：8.47,95％CI：2.12～33.89,P=0.003）、胃肠功能不全（OR：15.11,95％CI：3.454～66.10,P=0.000）是早期死亡的独立风险因素.A组患者术后3、5、10年生存率分别为98.5％、96.3％及96.3％,B组为90％、90％及83％（P=0.460）.结论 常温动脉转流下行全胸腹主动脉替换手术,能有效降低术后早期死亡率和持续神经系统并发症率,相比深低温停循环技术,是更为有效的手术方法.Objective Conventional technique with deep hypothermia circulatory arrest （DHCA） during extensive thoracoabdominal aortic aneurysm （TAAA） repair often complicated with high mortality and neurologi-cal complications, the optimal strategy for improving outcomes after TAAA repair remains unclear. We evalu-ated the protective effect of arterial bypass with normothermia technique during repair of extensive TAAAs. Methods From January 2005 to June 2017, a total of 190 patients with Crawford extend Ⅱ/Ⅲ underwent extensive thoracoabdominal aortic aneurysm （TAAA） repair and either with arterial bypass plus normothermia technique （group A） or with deep hypothermia circulatory arrest （group B）. In group A, 75 patients （55 men;age 40.7years; 54 patients （72%） with dissection） underwent arterial bypass procedure. In group B, 115 pa-tients with DHCA procedure （87 men; age 38.8 years; 99 patients （66.1%） with dissection）. The outcomes were compared by operative death （in-hospital death or death within 30 days of surgery） and permanent neu-rological complications （includes permanent stroke, paraplegia and cerebral hemorrhage）. Results The opera-tive death occurred in 1 patient （1.3%） and 9 patients （7.8%） in group A and group B （P=0.045）, respectively. The permanent neurological complications occurred in 5 patients （6.7%） and 19 patients （16.7%） in group A and group B （P=0.044）, respectively. Gastrointestinal dysfunction occurred in 1 patient （1.3%） in group A and in 12 patients （10.5%） in group B （P=0.015）, respectively, but there were no differences in occurrence of postoperative paraplegia, stroke and cerebral hemorrhage respectively between two groups （4 patients （5.4%） vs. 9 patients （7.8%）, P=0.506; 1 patients （1.3%） vs. 7 patients （6.1%）, P=0.111 and 1 patients （1.3%） vs. 3patients （2.6%）, P=0.483）. Multivariable analysis indicated that permanent neurological complications （OR：13.50,95%CI：3.48-52.36,P=0.00

关 键 词：动脉转流 深低温停循环 胸腹主动脉替换 

分 类 号：R65[医药卫生—外科学]