孙氏手术治疗头臂血管严重受损的A型主动脉夹层过程中血液动力学参数的意义  

Significance of hemodynamic parameters in the treatment of type A aortic dissection with severe cephalic-brachial vascular injury by Sun's procedure

作　　者：陈磊 孙江滨 CHEN Lei;SUN Jiangbin(Ward 3,Heart Center,Guilin People's Hospital,Guilin 541002,China)

机构地区：[1]桂林市人民医院心脏中心三病区,广西桂林541002

出　　处：《中国医学物理学杂志》2021年第8期1018-1022,共5页Chinese Journal of Medical Physics

基　　金：广西壮族自治区卫生和计划生育委员会科研课题(Z20170838)。

摘　　要：目的:探讨孙氏手术治疗头臂血管严重受损的A型主动脉夹层对血液动力学参数的影响。方法:选取125例头臂血管严重受损的A型主动脉夹层患者,对其行孙氏手术,观察体外循环时间、主动脉阻断时间、低流量选择性脑灌时间以及同期合并手术;并发症及30 d内死亡发生率;手术前后左室舒张末期内径(LVEDD)、心指数(CI)、中心静脉压(CVP)。结果:患者体外循环时间、主动脉阻断时间以及低流量选择性脑灌时间平均分别为(194.32±52.64)、(103.66±33.07)、(23.15±7.29)min,同期合并手术主要有Bentall手术、升主动脉替换、主动脉瓣成形;19例(15.20%)发生并发症,主要有神经系统并发症、多脏器功能不全甚至衰竭、肾功能不全甚至衰竭,8例(6.40%)30 d内死亡,主要死于多脏器功能不全甚至衰竭;与手术前比较,手术后患者LVEDD显著降低,CVP、CI显著升高,差异有统计学意义(P<0.05)。结论:孙氏手术治疗头臂血管严重受损的A型主动脉夹层不仅能够降低并发症发生率和死亡率,而且还能改善血液动力学参数,对临床治疗A型主动脉夹层有积极意义。Objective To explore the effects of Sun's procedure for type A aortic dissection with severe cephalic-brachial vascular injury on hemodynamic parameters.Methods A total of 125 patients with type A aortic dissection with severe cephalic-brachial vascular injury were enrolled for Sun's procedure.The cardiopulmonary bypass time,aortic occlusion time,low-flow selective cerebral perfusion time and concurrent surgeries were recorded.The incidences of complications and death within 30 days were analyzed,and moreover,left ventricular end-diastolic diameter(LVEDD),cardiac index(CI)and central venous pressure(CVP)before and after surgery were measured.Results The averages of cardiopulmonary bypass time,aortic occlusion time and lowflow selective cerebral perfusion time were(194.32±52.64),(103.66±33.07)and(23.15±7.29)min,respectively.The main concurrent surgeries included Bentall operation,replacement of ascending aorta and aortic valvuloplasty.A total of 19 cases(15.20%)had complications,mainly including nervous system complications,multiple organs dysfunction or even failure,renal dysfunction or even failure;and 8 cases(6.40%)died within 30 days,mainly died of multiple organ dysfunction or even failure.Compared with those before surgery,LVEDD was decreased significantly after surgery,while CVP and CI were increased significantly,and the differences were statistically significant(P<0.05).Conclusion Sun's procedure for type A aortic dissection with severe cephalic-brachial vascular injury can not only reduce the incidence of complications and mortality,but also improve hemodynamic parameters,having a positive significance for the clinical treatment of typeA aortic dissection.

关 键 词：孙氏手术 头臂血管 A型主动脉夹层 血流动力学参数 

分 类 号：R654[医药卫生—外科学]