内脏灌注对马方综合症合并胸腹主动脉置换的转流经验  

The management of visceral perfusion to Marfan syndrome with thoracoabdominal aortic aneurysm repair

作　　者：李川 杨璟[1] 邢家林[1] 朱俊明[2] 侯晓彤[1] LI Chuan;YANG Jing;XING Jialin;ZHU Junming;HOU Xiaotong(Department of Cardiopulmonary Bypass,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心脏外科危重症中心体外循环与机械辅助循环科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所主动脉外科中心,100029

出　　处：《心肺血管病杂志》2022年第10期1071-1075,共5页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:回顾分析马方综合征(MFS)接受内脏灌注的胸腹主动脉置换(TAAAR)手术患者,评估腹腔脏器保护的效果。方法:2016年9月至2020年8月,共有21例MFS接受TAAAR,其中9例接受内脏灌注。内脏灌注方式为温血灌注腹腔干和肠系膜上动脉;肾脏灌注冷HTK保护液。研究终点为患者死亡、延迟拔管、脑卒中、上下消化道出血、术后CRRT、截瘫或瘫痪。结果:灌注组在体外循环时间[(136.6±23.8)vs.(140.8±80.5)min]、体温[最低肛温(34.2±0.8)vs.(31.2±6.4)℃]、手术时间[(8.7±1.6)vs.(9.2±2.6)]h,均优于非灌注组。灌注组无死亡病例,未灌注组有1例院内术后死亡,死亡比例4.8%。非灌注组1例(8.3%)截瘫,灌注组没有截瘫。术后肾功能不全3例患者,其中灌注组1例(11.1%),非灌注组2例(16.7%)。TAAAR后两组均未见卒中、拔管时间延长、消化道出血。结论:MFS接受TAAAR的患者进行选择性内脏灌注与传统的手术相比安全有效,并且在死亡率、截瘫率、术后CRRT使用率等严重并发症方向有减少的趋势。Objective:To retrospectively analyze patients with Marfan syndrome(MFS)who underwent thoracoabdominal aortic aneurysm replacement(TAAAR)with visceral perfusion(VP),and to evaluate and summarize the effects of abdominal organ protection.Methods:From September 2016 to August 2020,a total of 21MFS patients underwent TAAAR,of which 9 was performed with VP.The VP was warm blood perfusion in the celiac and superior mesenteric artery;kidney perfusion with cold HTK protective solution.The study endpoints were death,prolonged intubation,stroke,upper and lower gastrointestinal bleeding,postoperative Continuous Renal Replacement Therapy(CRRT),and paraplegia or paralysis.Results:Compared with the non-VP group,the VP group had shorter average cardiopulmonary bypass(CPB)time[(136.6±23.8)vs.(140.8±80.5)min],higher body temperature[lowest rectal temperature(34.2±0.8)vs.(31.2±6.4)℃],and shorter operation time[(8.7±1.6)vs.(9.2±2.6)h]than the non-VP group,though the differences were not statistically significant.There was no death in the VP group,but one postoperative in-hospital death in the non-VP group,with the overall mortality rate being 4.8%.One patient(8.3%)in the non-VP group was paraplegic,and there was no paraplegia in the VP group.There were three patients with postoperative renal insufficiency,including one patient(11.1%)in the VP group and two patients(16.7%)in the non-VP group.There was no stroke,prolonged intubation time,or gastrointestinal bleeding in either group after TAAAR.Conclusions:Though the differences were not statistically significant,selective visceral perfusion in MFS patients undergoing TAAAR can show the tendency of reducing serious complications such as mortality,paraplegia,and postoperative CRRT usage.

关 键 词：马方综合征 胸腹主动脉置换术 内脏保护 部分体外循环 脊髓保护 

分 类 号：R54[医药卫生—心血管疾病]