胸主动脉腔内覆膜支架修复术对TBAD患者的影响  

Effect of thoracic aortic endovascular stent graft repair on patients with TBAD

作　　者：张绡绮 苏洁 武菲菲 吕珊 杨晶 周淑玲 段维勋 ZHANG Xiao-qi;SU Jie;WU Fei-fei;LYU Shan;YANG Jing;ZHOU Shu-ling;DUAN Wei-xun(Department of Cardiology,First Affiliated Hospital of Air Force Military Medical University,Xi’an Shaanxi 710032,China;Department of Neurology,First Affiliated Hospital of Air Force Military Medical University,Xi’an Shaanxi 710032,China)

机构地区：[1]空军军医大学第一附属医院心外科,陕西西安710032 [2]空军军医大学第一附属医院神经内科,陕西西安710032

出　　处：《局解手术学杂志》2021年第3期200-205,共6页Journal of Regional Anatomy and Operative Surgery

基　　金：国家自然科学基金(81870218)。

摘　　要：目的探讨胸主动脉腔内覆膜支架修复术对Stanford B型主动脉夹层(TBAD)患者的影响。方法选取我院收治的96例TBAD患者的临床资料,按照患者意愿分为联合组和对照组,每组48例。对照组给予药物治疗,联合组在对照组基础上联合胸主动脉腔内覆膜支架修复术治疗。比较2组患者住院时间、院内病死率、治疗前及治疗后1个月主动脉血管重塑情况,检测2组患者治疗前及治疗后1个月心功能指标左心室舒张末期内径(LVEDD)、左心室射血分数(LVEF)、左心室收缩末期内径(LVESD)、每搏心输出量(SV),肝肾功能指标丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、肌酐(Cr)、尿素氮(BUN)及外周血中性粒细胞与淋巴细胞比值(NLR)、D-二聚体(D-dimer)、心型脂肪酸结合蛋白(H-FABP)水平。术后随访12个月,采用Kaplan-Meier曲线分析2组患者生存状况。结果联合组住院时间短于对照组,院内病死率低于对照组(P<0.05)。治疗后1个月,联合组主动脉峡部段、降主动脉中段、降主动脉远段真腔短径长于对照组,假腔短径短于对照组(P<0.05);联合组LVEDD、LVESD短于对照组,LVEF、SV高/大于对照组(P<0.05);联合组血清ALT、AST、Cr、BUN低于对照组(P<0.05);联合组外周血NLR、D-dimer、H-FABP水平低于对照组(P<0.05)。Kaplan-Meier曲线分析显示,联合组术后12个月生存率高于对照组(P<0.05)。结论胸主动脉腔内覆膜支架修复术治疗TBAD可降低外周血NLR、D-dimer、H-FABP表达,改善主动脉血管重塑情况、心功能、肝肾功能,缩短住院时间,降低院内病死率,改善预后。Objective To investigate the effect of thoracic aortic endovascular stent graft repair on patients with Stanford type B aortic dissection(TBAD).Methods The clinical data of 96 TBAD patients admitted to our hospital were selected and divided into the combination group and the control group according to the patients’wishes,with 48 cases in each group.Patients in the control group received the medical treatment,while those in the combination group received thoracic aortic endovascular stent repair on the basis of the control group.The hospital stay,hospital mortality rate,and the remodeling of aortic vessels before treatment and 1 month after treatment were compared between the two groups.The cardiac function indexes[left ventricular end-diastolic diameter(LVEDD),left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),stroke volume(SV)],liver and kidney function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine(Cr),blood urea nitrogen(BUN)],peripheral blood neutrophil to lymphocyte ratio(NLR),D-dimer and heart-type fatty acid binding protein(H-FABP)before treatment and 1 month after treatment were compared between the two groups.The postoperative follow-up lasted for 12 months,and Kaplan-Meier curve was used to analyze the survival status of patients in the two groups.Results The hospital stay of the combination group was shorter than that of the control group,and the hospital mortality rate was lower than that of the control group(P<0.05).The short diameters of the true lumen of the aortic isthmus,middle descending aorta and distal descending aorta of the combination group 1 month after treatment were longer than those of the control group,and the short diameters of the false lumen were shorter than those of the control group(P<0.05).The LVEDD and LVESD of the combination group were shorter than those of the control group,and the LVEF and SV were higher/greater than those of the control group(P<0.05).The serum ALT,AST,Cr and BUN of the combination grou

关 键 词：胸主动脉腔内覆膜支架修复术 Stanford B型主动脉夹层 肝肾功能 中性粒细胞与淋巴细胞比值 D-二聚体 心型脂肪酸结合蛋白 

分 类 号：R543.1[医药卫生—心血管疾病]