右腋动脉和股动脉灌注对急性A型主动脉夹层手术的器官保护作用  

Protective effects of right axillary artery and femoral artery perfusion on acute type A aortic dissection

作　　者：陈洪松 王春生 彭润生 胡克俭 赵赟 罗海燕 CHEN Hongsong;WANG Chun-sheng;PENG Run-sheng(Department of Cardiac Surgery,Zhongshan Hospital,Fudan Univwesity,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院心外科,上海200032

出　　处：《中国实验诊断学》2020年第4期565-569,共5页Chinese Journal of Laboratory Diagnosis

摘　　要：目的本研究旨在比较右腋动脉插管(AXC)与右腋动脉+股动脉插管(AXC+FAC)灌注策略的临床效果以及对急性A型主动脉夹层(AAAD)手术的器官保护作用。方法纳入2009年1月到2014年3月本院收治的在深低温停循环(DHCA)结合顺行脑灌注(ACP)下行急性A型主动脉夹层手术的74例患者。根据不同的插管策略,患者被分为两组:AXC组(n=30例),AXC+FAC组(n=44例);分别评估其术后神经功能不全、肾功能不全、肺功能不全、住院死亡等主要不良后果。结果两组患者心肌缺血时间比较差异无统计学意义(P=0.975);体外循环时间(P=0.001),脑灌注时间(P=0.034)和下半身停循环时间(P<0.0001)比较均有显著性差异。AXC+FAC组的△SCr(P=0.005)显著少于AXC组;AXC+FAC组患者血红细胞和血浆输注显著少于AXC组(P=0.020和P<0.0001)。两组患者在机械通气,气管切开,血液透析,神经功能障碍及住院死亡率比较差异无统计学意义(P>0.05)。结论与右腋动脉插管相比,采用右腋动脉和股动脉插管的灌注策略对急性A型主动脉夹层手术是安全的方法,可以有效保护脏器。Objective This study aimed to compare the clinical effects on the AXC to AXC+FAC perfusion strategy and evaluate potential protection on lower function after acute Type A aortic dissection(AAAD)surgery.Methods Between January 2009 and March 2014,74 consecutive patients(mean age was 52.2±8.9 years,57 males and 17 females)who underwent open aortic arch replacement for AAAD at our institution were retrospectively evaluated.All surgeries were performed under deep to moderate hypothermia with antegrade cerebral perfusion(ACP).Our patient corhort was divided into two group according to the cannulation strategy,those with AXC(Group AXC,n=30)and those with double cannulation of FAC and AXC(Group AXC+FAC,n=44).Major adverse outcomes of neurologic dysfunction,renal dysfunction,pulmonary insufficiency and in-hospital death were examined.Results There was no significant difference between the two groups in myocardial ischemic time(P=0.975).CPB time(P=0.001),ACP time(P=0.034)and lower body circulatory arrest time(P<0.0001),△Scr(P=0.005)in the AXC+FAC patients were significantly shorter than that in the AXC patients.The AXC+FAC patients required significantly fewer red blood cell and serum transfusion than the AXC patients(P=0.020 and P<0.0001,respectively).No statistical difference was detected in mechanical ventilation,tracheostomy,hemodiafiltration,neruologic dysfunction and in-hospital mortality(P>0.05)between the two groups,Conclusion Compared to AXC,the double cannulation of right axillary artery and femoral artery is safe technique for open aortic arch reconstruction,and has effective protection on visceral organs.

关 键 词：主动脉夹层 腋动脉 股动脉 肾功能不全 

分 类 号：R654[医药卫生—外科学]