三种术式治疗急性Stanford A型主动脉夹层效果对比研究  

Comparative study of three surgical methods in the treatment of acute Stanford type A aortic dissection

作　　者：田永仓[1] 赵丹[1] 柏本健[1] 聂太宝[1] 韦庄怡 杜肖 Tian Yongcang;Zhao Dan;Bai Benjian;Nie Taibao;Wei Zhuangyi;Du Xiao(Department of Cardiothoracic Surgery,Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang 712000,China)

机构地区：[1]陕西中医药大学第二附属医院心胸外科,咸阳712000

出　　处：《山西医药杂志》2021年第18期2633-2636,共4页Shanxi Medical Journal

基　　金：陕西省中医药管理局科研课题(LCPT075);陕西中医药大学第二附属医院学科创新团队项目(2020XK-TD-C06)。

摘　　要：目的对比分析3种术式治疗急性Stanford A型主动脉夹层的效果。方法选择我院于2018年1月至2020年1月急性Stanford A型主动脉夹层患者92例,依据术式不同分为A组(34例)、B组(26例)和C组(32例)。A组患者采用孙氏手术治疗,B组患者采用改良孙氏手术治疗,C组患者采用去分支复合手术治疗。比较3组机械通气时间、术后引流量、术后住院时间、体外循环时间、主动脉阻断时间及并发症发生情况,比较术前和术后72 h肝功能指标[天冬氨酸转氨酶(AST)和丙氨酸转氨酶(ALT)]和肾功能指标[肌酐(Cr)和尿素氮(BUN)]水平变化,随访12个月患者预后情况。结果C组患者机械通气时间和术后住院时间短于A组和B组,术后引流量少于A组和B组(P<0.05);B组患者机械通气时间和术后住院时间短于A组,术后引流量少于A组(P<0.05)。C组患者体外循环时间和主动脉阻断时间短于A组和B组(P<0.05);B组患者体外循环时间和主动脉阻断时间短于A组(P<0.05)。C组患者并发症发生率低于A组和B组(P<0.05);B组并发症发生率低于A组(P<0.05)。3组术后72 h患者AST和ALT水平低于术前(P<0.05);C组术后72 h患者AST和ALT水平低于A组和B组,且B组低于A组(P<0.05)。3组术后72 h患者Cr和BUN水平低于术前(P<0.05);C组术后72 h患者Cr和BUN水平低于A组和B组,且B组低于A组(P<0.05)。结论相比于孙氏手术和改良孙氏手术,去分支复合手术具有一定的优越性,可减轻肝肾功能损伤,缩短机械通气时间,且预后良好。Objective To compare and analyze the effect of three surgical methods in the treatment of acute Stanford type A aortic dissection.Methods A total of 92 patients with acute Stanford type A aortic dissection admitted to Second Affiliated Hospital of Shanxi University of Traditional Chinese Medicine from January 2018 to January 2020 were selected and divided into group A(n=34),group B(n=26)and group C(n=32)according to different operation methods.Patients in group A,B and C were treated with Sun's operation,modified Sun's operation,and debranching combined operation,respectively.The time of mechanical ventilation,postoperative drainage,postoperative hospital stays,cardiopulmonary bypass time,aortic occlusion time,complications,liver function indexes[aspartate aminotransferase(AST)and alanine aminotransferase(ALT)]and renal function indexes[creatinine(CR)and urea nitrogen(BUN)]before and 72 hours after operation were compared among the three groups.The prognosis of the patients was followed up for 12 months.Results The mechanical ventilation time,postoperative hospital stays of patients and the postoperative drainage volume in group C were shorter or less than those of group A and group B(P<0.05).The mechanical ventilation time,postoperative hospital stays and postoperative drainage volume of patients in group B were shorter or less than those of group A(P<0.05).The cardiopulmonary bypass time and aortic clamping time of patients in group C were shorter than those of group A and group B(P<0.05),and these indicators in group B were shorter than those in group A(P<0.05).The complications for patients in group C were lower than group A and group B(P<0.05),and the complications in group B were lower than group A(P<0.05).The levels of AST,ALT,Cr and BUN in three groups at 72 hours after operation were lower than that before operation(P<0.05).The levels of AST,ALT,Cr and BUN in group C at 72 hours after operation were lower than that in group A and group B,and those in group B were lower than group A(P<0.05).Conclusion Com

关 键 词：急性Stanford A型主动脉夹层 改良孙氏手术 去分支复合手术 

分 类 号：R654.3[医药卫生—外科学]