COVID-19疫情期间急性主动脉夹层手术湖北省多中心管理经验总结及建议  

Suggestions and summaries on multi-center management of acute aortic dissection surgery during COVID-19 epidemic in Hubei province

作　　者：吴龙 黄晓帆 刘隽炜 邱雪峰 刘小斌 蒋雄刚[1] 张郁林[2] 张松林[3] 黄江平[4] 刘伟 张军[6] 董家寿[7] 陈家军[8] 夏家红[1] 董念国[1] Wu Long;Huang Xiaofan;Liu Junwei;Qiu Xuefeng;Liu Xiaobin;Jiang Xionggang;Zhang Yulin;Zhang Songlin;Huang Jiangping;Liu Wei;Zhang Jun;Dong Jiashou;Chen Jiajun;Xia Jiahong;Dong Nianguo(Union Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China;Peoples Hospital of Three Gorges University,the First Peoples Hospital of Yichang,Yichang 443000,China;The First Clinical Medical College of Three Gorges University,Yichang Central Peoples Hospital,Yichang 443003,China;Jingzhou Central Hospital,Jingzhou 434020,China;Affiliated Dongfeng Hospital of Hubei University of Medicine,Sinopharm Dongfeng General Hospital,Shiyan 442008,China;Shiyan Taihe Hospital,Shiyan 442000,China;Jingmen First Peoples Hospital,Jingmen 448000,China;Xiangyang Center Hospital,Xiangyang 441021,China)

机构地区：[1]华中科技大学同济医学院附属协和医院,武汉430022 [2]三峡大学人民医院宜昌市第一人民医院,443000 [3]三峡大学第一临床医学院宜昌市中心人民医院,443003 [4]荆州市中心医院,434020 [5]湖北医药学院附属东风医院国药东风总医院,十堰442008 [6]十堰市太和医院,442000 [7]荆门市第一人民医院,448000 [8]襄阳市中心医院,441021

出　　处：《中华胸心血管外科杂志》2020年第7期397-401,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金项目(81800413,81730015)。

摘　　要：目的探讨新型冠状病毒肺炎(COVID-19)疫情期间急性主动脉夹层患者合适的治疗方案。方法自2020年1月16日至2月26日,湖北省多个心脏大血管中心共完成37例急性主动脉夹层手术,包括Stanford A型主动脉夹层开放手术18例,Stanford B型主动脉夹层介入手术19例。急性Stanford A型主动脉夹层手术方式包括Stanford升主动脉置换10例(55.55%),Bentall手术7例(38.89%);全弓置换+支架象鼻手术14例(77.8%)。19例急性Stanford B型主动脉夹层行胸主动脉覆膜支架腔内隔绝术,2例同时采用左锁骨下动脉的烟囱技术。结果本组住院30天内无死亡病例。术前核酸检测排除新型冠状病毒感染7例,疑似3例进行急诊手术。大部分手术(62.2%,23/37)采用了三级防护,11例主动脉夹层术后复查病毒核酸检测均为阴性,目前尚未发生医护人员感染及患者交叉感染。结论在疫情期间,术前应仔细鉴别急性主动脉夹层患者是否合并COVID-19。应遵循"肺炎疫情防控为重,确诊病例首选保守,择期手术尽量延迟,急危重症合理手术"治疗原则,可以最大限度挽救患者生命,避免疫情扩散。Objective Since December 2019,novel coronavirus infection has occurred in Hubei province and spread throughout the country quickly.This new crown viral pneumonia was named as coronavirus disease of 2019(COVID-19)by WHO.However,at present,there is a high incidence of acute aortic dissection in winter and spring.How to prevent the spread of the epidemic and choose the appropriate treatment is an important topic for the patients with acute aortic dissection.Methods From January 16,2020 to February 26,2020,a total of 37 of acute aortic dissection operations were carried out in several cardiovascular surgery centers in Hubei Province.There were 18 cases of Stanford type A aortic dissection and 19 cases of Stanford type B aortic dissection.There were 10 cases(55.55%)with ascending aorta replacement and 7 cases(38.89%)with Bentall procedure for aortic root surgery,and total arch replacement with stented elephant trunk implantation were performed in 14 cases(77.8%).In 19 patients with Stanford type B aortic dissection,thoracic endovascular aortic repair was performed,with the left subclavian artery chimney technique in 2 cases.Results No deaths occurred within 30 days of hospitalization.Preoperative nucleic acid testing excluded 7 cases of novel coronavirus infection,and 3 suspected cases underwent emergency surgery.the three-level protective standard was adopted in the majority of the surgeries(62.2%,23/37),and 11 patients were negative in the reexamination of viral nucleic acid after the operation.Conclusion During the epidemic period,patients with acute aortic dissection should be carefully identified with actife COVID-19 before surgery.The treatment principles-"prevention and control of pneumonia epidemic should be emphasized,conservative medical management should be taken in the comfirmed cases,the selective operation should be delayed as far as possible,and the operation should be reasonable performed in critical cases"should be followed,which can save patients'lives to the greatest extent and prevent the spread of

关 键 词：新型冠状病毒肺炎 心血管外科 主动脉夹层 急诊手术 

分 类 号：R654.3[医药卫生—外科学]