浅低温联合术中支架象鼻内球囊阻断技术与传统孙氏手术的对比研究  

A comparative study of intra-aortic balloon occlusion technique under shallow hypothermia and conventional Sun’s procedure

作　　者：吴丽映 朱大量 陈海生 叶东挺 张雄 李彬[1] 李观青 WU Li-ying;ZHU Da-liang;CHEN Hai-sheng;YE Dong-ting;ZHANG Xiong;LI Bin;LI Guan-qing(Department of Cardiovascular Surgery,Guangzhou First People's Hospital,School of Medicine,South China university of Technology,Guangzhou 510180,China)

机构地区：[1]广州市第一人民医院心脏大血管外科,广东省广州市510180

出　　处：《中国心血管病研究》2021年第8期688-692,共5页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨支架象鼻内球囊阻断联合浅低温停循环、双侧脑灌注技术与传统孙氏手术在Stanford A型主动脉夹层术中的对比。方法回顾性分析2019年1月至2020年12月在我院接受孙氏手术治疗的81例急性Stanford A型主动脉夹层患者资料。根据术中操作方式分为传统组和改良组,传统组按照传统孙氏手术方式处理主动脉弓部,在肛温25℃停循环选择性脑保护。改良组采用支架象鼻内球囊阻断联合浅低温停循环、双侧脑灌注技术,在肛温30℃停循环,支架象鼻内球囊阻断后立即恢复全流量灌注。比较两组患者的术前、术中及术后情况,探讨该术式的安全性和有效性。结果传统组(55例)术后死亡4例,改良组(26例)死亡1例。术后昏迷、截瘫、术后连续性肾脏替代治疗使用率等并发症发生率无显著差异,术后短暂性神经系统并发症传统组显著多于改良组。传统组与改良组在停循环时间[(26.6±2.1)比(2.6±1.2)min]、主动脉阻断时间[(149.4±22.6)比(101.2±13.6)min]、体外循环时间[(222.2±35.8)比(187.7±36.3)min]、手术时间[(482.4±36.1)比(401.2±13.6)min]上差异具有统计学意义(P<0.05);传统组与改良组的围手术期输注红细胞[(737±374)比(451±407)ml]、术后清醒时间[(17.6±9.8)比(7.2±4.3)h]、机械辅助通气时间[(61.1±13.3)比(31.0±9.4)h]、ICU停留时间[(5.5±1.6)比(3.1±1.1)d]、住院时间[(20.8±2.1)比(12.7±2.4)d]、术后肾功能改变等差异具有统计学意义(P<0.05),改良组围术期红细胞用量明显少于传统组,术后恢复优于传统组。结论支架象鼻内球囊阻断联合浅低温停循环、双侧脑灌注技术能明显缩短各操作时间和手术时间,减少输血,有益于保护全身脏器,术后康复快,在合适病例中值得临床推荐应用。Objective To explore the effectiveness and safety of intra-aortic balloon occlusion technique under shallow hypothermia to treat acute Stanford type A aortic dissection.Methods The clinical data of 81 patients with acute Stanford type A aortic dissection treated with Sun’s procedure(frozen elephant trunk and total arch replacement with a 4-branched graft)at our hospital between January 2019 and December 2020 were retrospectively analyzed.According to the methods of operation,they were divided into the conventional(55 cases)and the modified(26 cases)group.The conventional group was dealt with the traditional Sun’s surgery with selective cerebral protection by circulatory arrest at the temperature of 25℃.In the modified group,the circulation was arrested at the temperature of 30℃with bilateral cerebral perfusion technique,and full-flow perfusion was resumed immediately after the intra-aortic balloon occlusion.The preoperative,intraoperative,and postoperative conditions of the two groups were recorded and compared to investigate the safety and effectiveness of this procedure.Results There were four postoperative deaths in the conventional group and one death in the modified group.No significant difference was found in the incidence of complications such as postoperative coma,paraplegia and continuous renal replacement therapy usage between 2 groups,but postoperative transient neurological complications were significantly higher in the conventional group.In terms of mean circulation arrest time[(26.6±2.1)min vs.(2.6±1.2)min],mean aortic cross-clamp time[(149.4±22.6)min vs.(101.2±13.6)min],mean cardiopulmonary bypass time[(222.2±35.8)min vs.(187.7±36.3)min]and mean operating time[(482.4±36.1)min vs.(401.2±13.6)min]all decreased in the modified group(P<0.05).Perioperative red blood cell infusion[(737±374)ml vs.(451±407)ml],postoperative awake time[(17.6±9.8)h vs(7.2±4.3)h]mechanical assisted ventilation time[(61.1±13.3)h vs(31.0±9.4)h],ICU stay[(5.5±1.6)d vs(3.1±1.1)d],length of hospital stay[(2

关 键 词：急性A型主动脉夹层 浅低温 球囊阻断 支架象鼻技术 

分 类 号：R543.1[医药卫生—心血管疾病]