A型主动脉壁间血肿的单中心治疗经验  

Treatment of Type A Aortic Intramural Hematoma: a Single Center Experience

作　　者：唐滔[1] 董阿兰[1] 唐浩[1] 宋国宝[1] 张剑锋 周新民[1] TANG Tao;DONG Alan;TANG Hao;SONG Guobao;ZHANG Jianfeng;ZHOU Xinmin(Department of Cardiovascular Surgery,The Second Xiangya Hospital,Central South University,Changsha(410011),Hunan,China)

机构地区：[1]中南大学湘雅二医院心血管外科,湖南省长沙市410011

出　　处：《中国循环杂志》2022年第3期265-269,共5页Chinese Circulation Journal

摘　　要：目的:总结我院A 型主动脉壁间血肿(IMH)的治疗经验,探讨其治疗策略。方法:回顾性纳入2015年1月至2020年12月我院收治的135例急性A 型IMH患者,根据病情分为稳定型(n=43)和不稳定型(n=92)A 型IMH 患者。稳定型A 型IMH患者主要采用药物治疗,不稳定型A 型IMH 患者首选手术治疗。结果:在43例稳定型A 型IMH 患者中,31例经严格药物治疗后好转出院,药物治疗有效率72.1%;6例(14.0%)在观察期中转为手术治疗,另有6例(14.0%)转为介入治疗,无住院死亡;随访均存活。在92例不稳定型A 型IMH患者中,69例(75.0%)接受急诊外科手术,无住院死亡,随访死亡4例,死亡率5.8%(4/69);23例(25.0%)拒绝手术,选择药物治疗,其中住院死亡2例,随访死亡3例,死亡率21.7%(5/23)。不稳定型A 型IMH 患者的总死亡率为9.8%(9/92)。结论:A 型IMH 的治疗可根据其可能的转归相应处理:稳定型A 型IMH 患者可首选药物治疗,同时“等待并观察”;而不稳定型A 型IMH 患者宜首选急诊手术治疗。Objectives: To summarize the treatment experience of type A aortic intramural hematoma(IMH) and explore suitable treatment strategy.Methods: Clinical data of 135 patients with acute type A IMH treated in our center from January 2015 to December 2020were analyzed and patients were divided into stable type A IMH(n=43) and unstable type A IMH(n=92). Stable type A IMH is mainly conservative treated with drugs, and surgery is the first choice for unstable type A IMH.Results: Among 43 stable type A IMH patients, 31 cases improved and discharged after strict drug treatment, the effective rate of drug treatment was 72.1%. Another 6 cases(14.0%) were converted to surgical treatment during the observation period, and another 6 cases(14.0%) were converted to interventional treatment, there was no in-hospital death. There was no death during follow-up. Among 92 cases of unstable type A IMH, 69(75.0%) underwent emergency surgery, there was no inhospital death, 4 cases died during post-discharge follow-up, and the mortality rate was 5.8%(4/69). Twenty-three unstable type A IMH patients(25.0%) refused to receive operation and were conservatively treated with drugs, 2 cases died during hospitalisation and 3 cases died during post-discharge follow-up. The mortality was 21.7%(5/23) for unstable type A IMH,who did not receive emergency surgery. The total mortality of unstable type A IMH patients was 9.8%(9/92).Conclusions: The treatment strategy of patients with type A IMH depends on the stable stutus. For patients with stable type A IMH, drug treatment can be viewed as the first choice, and "wait and watch" strategy is suitable for them. For patients with unstable type A IMH, emergency surgery is the first choice. In general, the clinical outcome of acute type A IMH patients is satisfactory after suitable therapy strategies.

关 键 词：A型壁间血肿 主动脉 治疗策略 药物治疗 手术治疗 

分 类 号：R54[医药卫生—心血管疾病]