升主动脉和头臂干双动脉插管在急性A型主动脉夹层手术中应用的倾向性评分匹配分析  

Application of ascending aorta cannulation and brachiocephalic trunk cannulation in acute type A aortic dissection:A propensity-score matching study

作　　者：孙科雄 张力[1] 高夏[1] 崔聪[1] 张向辉 肖长波[1] 张亚飞 武刚[1] 王平凡[1] SUN Kexiong;ZHANG Li;GAO Xia;CUI Cong;ZHANG Xianghui;XIAO Changbo;ZHANG Yafei;WU Gang;WANG Pingfan(The Eighth Ward of Cardiovascular Surgery,Henan Province Chest Hospital,Zhengzhou,450003,P.R.China)

机构地区：[1]河南省胸科医院心血管外科八病区,郑州450003

出　　处：《中国胸心血管外科临床杂志》2021年第3期325-330,共6页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：河南省医学科技攻关计划项目(LHGJ20200226)。

摘　　要：目的探讨升主动脉、头臂干双动脉插管在急性A型主动脉夹层手术中的应用。方法筛选2017年1月至2020年1月我院急性A型主动脉夹层患者183例,其中42例采用升主动脉、头臂干双动脉插管建立体外循环,为DAC组(男33例、女9例,中位年龄50岁);141例采用单独腋动脉插管建立体外循环,为AAC组(男116例、女25例,中位年龄51岁)。比较两组倾向性评分匹配前后的一般临床资料、术中资料和术后早期结果。结果倾向性评分匹配前,DAC组手术时间、体外循环时间、主动脉阻断时间和住ICU时间均短于AAC组,差异有统计学意义(P<0.05)。术后早期死亡、脑部并发症、肾功能衰竭和肺部并发症发生率DAC组明显低于AAC组。倾向性评分匹配后,DAC组手术时间较AAC组明显缩短(P<0.05);术后早期死亡、脑部并发症和肺部并发症发生率DAC组明显低于AAC组(P<0.05)。结论升主动脉、头臂干双动脉插管为部分急性A型主动脉夹层患者提供一种安全、快速、有效建立体外循环的方法,在不增加手术并发症的同时明显缩短手术时间。Objective To investigate the application of ascending aorta cannulation and brachiocephalic trunk cannulation in acute type A aortic dissection.Methods We screened 183 patients with acute type A aortic dissection from January 2017 to January 2020 in our hospital.They were divided into 2 groups according to the cannulation strategy:ascending aorta cannulation and brachiocephalic trunk cannulation(a DAC group,n=42,33 males and 9 females with a median age of 50 years)and the single axillary artery cannulation(an AAC group,n=141,116 males and 25 females with a median age of 51 years).The general clinical data,intraoperative data and early postoperative results of the two groups before and after matching with propensity scores were compared.Results Before propensity-score matching,the operation time,cardiopulmonary bypass time,aortic occlusion time and ICU stay in the DAC group were all shorter than those in the AAC group(P<0.05).The early postoperative mortality,and rates of brain complications,renal failure and pulmonary complications in the DAC group were significantly lower than those in the AAC group.After propensity-score matching,the operation time in the DAC group was significantly shorter than that in the AAC group(P<0.05).The early postoperative mortality,and rates of brain complications and pulmonary complications in the DAC group were significantly lower than those in the AAC group.Conclusion Ascending aorta cannulation and brachiocephalic trunk cannulation can provide a safe,fast and effective method of establishing cardiopulmonary bypass for some acute type A aortic dissection patients,and significantly shorten the operation time without increasing surgical complications.

关 键 词：急性A型主动脉夹层 动脉插管 体外循环 倾向性评分匹配 手术 

分 类 号：R654.2[医药卫生—外科学]