急性Stanford A型主动脉夹层合并反复胸痛的外科救治  

Surgical treatment of acute Stanford type A aortic dissection complicated by recurrent chest pain

作　　者：肖长波[1] 喻红霞[2] 毛蕾芳[1] 张力[1] 张亚飞 孙科雄 高夏[1] 武刚[1] 崔聪[1] 张向辉 陈玉新 杜聪 王平凡[1] Xiao Changbo;Yu Hongxia;Mao Leifang;Zhang Li;Zhang Yafei;Sun Kexiong;Gao Xia;Wu Gang;Cui Cong;Zhang Xianghui;Chen Yuxin;Du Cong;Wang Pingfan(Ward VⅢ,Department of Cardiovascular Surgery,Henan Chest Hospital,Zhengzhou 450001,China;The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院心血管外科八病区,郑州450001 [2]郑州大学第二附属医院,郑州450000

出　　处：《中国实用医刊》2022年第4期1-4,共4页Chinese Journal of Practical Medicine

基　　金：河南省医学科技攻关计划项目(2018020551)。

摘　　要：目的总结分析急性Stanford A型主动脉夹层合并反复胸痛的外科急诊救治经验。方法回顾性分析河南省胸科医院心血管外科八病区同一手术组于2014年1月至2020年1月收治的29例急性Stanford A型主动脉夹层合并反复胸痛患者的病例资料。结果29例患者中,11例于术前死亡,18例行急诊手术治疗,门诊至手术室时间31~97(39±27)min,手术时间253~455(415±23)min,深低温停循环时间11~23(14.0±4.7)min,主动脉阻断时间89~129(105±17)min,体外循环时间132~223(186±31)min。18例手术患者死亡4例,死因:术后严重脑部并发症2例、严重消化道出血伴肠梗阻导致全身多脏器功能衰竭1例、严重感染导致多脏器功能不全死亡1例。术后随访3个月~7年,随访期间2例失访,1例猝死(死因不详),1例于术后2年突发脑出血伴右侧肢体偏瘫,其他患者CT血管造影检查未见支架膨胀不全和吻合口漏。结论急性Stanford A型主动脉夹层合并反复胸痛术前猝死风险高,急诊手术是救治的唯一有效手段,且手术预后良好。Objective To investigate the emergency surgical treatment of acute Stanford type A aortic dissection complicated by recurrent chest pain.Methods A retrospective analysis was performed on clinical data from 29 cases of acute Stanford type A aortic dissection complicated by recurrent chest pain admitted to the same surgical group from January 2014 to January 2020 in the WardⅧof Department of Cardiovascular Surgery of Henan Chest Hospital.Results Among the 29 patients,11 cases died before operation,and 18 cases underwent emergency operation.The time from outpatient to operating room was 31-97(39±27)min,the length of operation was 253-455(415±23)min,the deep hypothermic circulatory arrest time was 11-23(14.0±4.7)min,aortic occlusion time was 89-129(105±17)min,and cardiopulmonary bypass time was 132-223(186±31)min.Four of the 18 patients died,and the causes of death included severe brain complications after surgery(2 cases),systemic multiple organ failure caused by severe gastrointestinal bleeding complicated by intestinal obstruction(1 case),and multiple organ dysfunction caused by severe infection(1 case).During the follow-up period(3 months to 7 years),2 cases lost follow-up,1 case died suddenly(the cause of death was unknown),1 case had acute intracerebral hemorrhage with hemiplegia of the right limb 2 years after operation,and the rest patients had no stent dilatation and anastomotic leakage according to CT angiography.Conclusions Patients with acute Stanford type A aortic dissection complicated by recurrent chest pain has a high risk of sudden death before surgery.Emergency surgery is the only effective treatment method,and has a good prognosis.

关 键 词：主动脉夹层 Stanford A型 休克 急诊手术 术后并发症 

分 类 号：R654.3[医药卫生—外科学]