分支优先主动脉全弓置换和支架“象鼻”术的临床应用  

Clinical outcomes of branch first total aortic arch replacment+stent elephant trunk

作　　者：刘新波[1] 李有金[1] 张华[1] 杨海波 牛涛[1] 张亚政[1] LIU Xinbo;LI Youjin;ZHANG Hua;YANG Haibo;NIU Tao(Department of Cardiovascular Suegery,Ningxia Hui Autonomous Regin People’s Hospital,Yinchuan 750004,China)

机构地区：[1]宁夏回族自治区人民医院心脏大血管外科,750004

出　　处：《心肺血管病杂志》2020年第7期822-825,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:比较分支优先主动脉全弓置换+支架“象鼻”(孙氏手术Sun’s procedure)和经典孙氏手术在主动脉弓部疾病患者中的优劣。方法:2018年1月至2020年2月,宁夏回族自治区人民医院心血管中心心脏大血管外科共行分支优先孙氏手术30例,选取同期收治年龄、性别相匹配经典孙氏术30例为对照组。收集所有患者术前、术中、围术期临床资料,比较两组患者治疗效果。结果:两组患者术前临床资料差异无统计学意义(P>0.05)。分支优先组和经典孙氏组相比,手术时间短[(387.26±22.65)vs.(490.46±34.16)min,P<0.01]、体外循环时间短[(165.62±30.22)vs.(214.39±12.38)min,P<0.05]、主动脉阻断时间短[(78.56±16.24)vs.(125.08±22.56)min,P<0.01]、围术期病死率低(3.3%vs.10.0%,P<0.05)、术后呼吸衰竭发生率低(6.7%vs.16.7%,P<0.05)、术后神经系统并发症少(10.0%vs.23.3%,P<0.05)、术后24 h引流量及输血量少[(487.48±98.25)vs.(702.33±165.19)mL,(358.61±86.77)vs.(588.04±113.91)mL,P<0.01]、ICU停留时间短[(26.49±8.26)vs.(40.28±11.92)h,P<0.05]。两组患者心力衰竭、肾衰竭、二次开胸、术后住院天数、胸骨骨髓炎等围术期并发症方面比较,差异无统计学意义(P>0.05)。结论:采用分支优先孙氏手术治疗主动脉疾病,近期临床效果良好。Objective:To compare the advantages and disadvantages of Branch first total aortic arch replacment+stent elephant trunk(Sun’s procedure)and classical Sun’s procedure in patients with aortic disease.Methods:Between March 2018 and February 2020,30 patients who were underwent branch first Sun’s procedure in Cardiovascular Suegery of Ningxia Hui autonomous Regin People’s Hospital.and another 30 patients in control group underwent classical Sun’s procedure matched with age and sex.Collect the clinical data of all patients before,during and around operation,and compare the therapeutic effect of the two groups.Results:There were no significant difference in preoperative clinical rate Between two groups.Compared with the classic sun’s procedure group,The operation time was shorter[(387.26±22.65)vs.(490.46±34.16)min,P<0.01],the cardiopulmonary bypass time was shorter[(165.62±30.22)vs.(214.39±12.38)min,P<0.05],The time of aortic occlusion was shorter[(78.56±16.24)vs.(125.08±22.56)min,P<0.01],the perioperative mortality was lower(3.3%vs.10.0%,P<0.05),the incidence of postoperative respiratory failure was lower(6.7%vs.16.7%,P<0.05),and the postoperative neurological complications were less(10.0%vs.23.3%,P<0.05),the volume of blood flow and transfusion was less in 24 hours after operation[(487.48±98.25)vs.(702.33±165.19)mL,(358.61±86.77)vs.(588.04±113.91)mL,P<0.01],the duration of ICU was shorter[(26.49±8.26)vs.(40.28±11.92)h,P<0.05].There were no significant differ-ence in perioperative complications such as heart failure,renal failure,two thoracotomy,postoperative hospital stay,sternal osteomyelitis(P>0.05).Conculsions:Branch first sun’s prcedure was used to treat aortic diseases,with good clinical effect in the near future.

关 键 词：主动脉疾病 主动脉全弓置换+支架“象鼻”术 分支优先 孙氏手术 

分 类 号：R54[医药卫生—心血管疾病]