分支优先技术治疗主动脉A型夹层的围术期经验  

‘Branched-first’technique for surgical repair in Stanford type A aortic dissection

作　　者：阳晟[1] 薛源[1] 姜文剑[1] 张友聪 高慧强[1] 李建荣[1] 潘旭东[1] 董松波[1] 孙立忠[1] 郑军[1] YANG Sheng;XUE Yuan;JIANG Wenjian;ZHANG Youcong;GAO Huiqiang;LI Jianrong;PAN Xudong;DONG Songbo;SUN Lizhong;ZHENG Jun(Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2020年第9期1080-1084,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京自然科学基金-海淀原始创新联合基金项目(L192010);国家重点研发计划(2017YFC1308000);国家自然科学基金(8180020084)。

摘　　要：目的:Stanford A型主动脉夹层(STAAD)是一种危重的心血管疾病,外科手术仍是首选治疗方法。传统的手术方式的病死率和神经系统并发症仍然很高。在这项研究中,我们介绍了一种基于分支优先技术的孙氏手术,并探讨该技术与STAAD患者术后结果的关系。方法:2017年7月至2018年10月期间,在北京安贞医院,接受主动脉弓部置换和支架象鼻手术的92例STAAD患者纳入分析。将患者分为两组:分支优先组和经典组。分支优先组24例(26.1%),经典组68例(73.9%)。结果:分支优先组的体外循环时间[(172.4±29.9)vs.(198.9±51.1)min,P=0.018]、ICU住院时间[17.0(14.6,38.2)vs.45.6(19.7,89.9)h,P<0.001]、机械通气时间[15.5(11.9,40.0)vs.22.8(17.9,65.6)h,P=0.006]明显短于经典组。在多变量Logistic回归模型中,分支优先与术后神经并发症的减少有关(OR=0.14,95%CI:0.02~0.59,P=0.047)。结论:分支优先技术的优点包括:术中使用双侧脑灌注,低温停循环下较高的鼻咽温和术中较短的体外循环时间。这有助于缩短术后患者的恢复时间并减少围手术期神经系统并发症的发生。Objective:Stanford type A aortic dissection(STAAD)is a critical cardiovascular disease,and surgical procedure is the first-choice treatment.The classical surgical procedure still leads to a high mortality rate and neurological complications.In this study,we introduce a new modified Sun’s procedure and investigate the association between the branch-first technique and the postoperative outcomes of patients with STAAD.Methods:All patients(n=152)with STAAD who underwent classic Sun’s procedure surgery at Beijing Anzhen Hospital between July 2017 and October 2018 were included in this retrospective study.Patients with STAAD that involved only the ascending aorta and those with hemodynamic instability that required rapid CPB establishment were excluded from the analysis.After the exclusion of 60 patients who received the Bentall/David/ascending aortic replacement+Sun’s procedure,92 patients with STAAD who underwent arch replacement and stent elephant trunk procedure were included in the analysis.The patients were divided into two groups:the branch-first group and the classic group.The branch-first group and the classic group comprised 24 patients(26.1%)and 68 patients(73.9%),respectively.Results:Patients in the branch-first group had a significantly shorter cardiopulmonary bypass(CPB)duration[(172.4±29.9)vs.(198.9±51.1)min,P=0.018]Intensive care unit(ICU)stay[17.0(14.6,38.2)vs.45.6(19.7,89.9)h,P<0.001],and mechanical ventilation time[15.5(11.9,40.0)vs.22.8(17.9,65.6)h,P=0.006]than patients in the classic group.In the multivariate Logistic regression model,branched-first technique was associated with a reduction in postoperative neurological complications(OR=0.14,95%CI:0.02-0.59,P=0.047).Conclusions:The benefits of the branch-first technique,including lower CPB duration,better bilateral cerebral perfusion,and higher nasopharyngeal temperature during hypothermic arrest,contributed to a shortened recovery time for patients after surgery.

关 键 词：主动脉A型夹层 分支优先 孙氏手术 

分 类 号：R54[医药卫生—心血管疾病]