手术治疗高龄急性Stanford A型主动脉夹层患者的临床效果分析  

Clinical effect analysis of surgical treatment on elderly patients with acute Stanford A aortic dissection

作　　者：黄坛坛 郭宝英 王瑶婕 张华[1] 杨海波 李有金[1] HUANG Tantan;GUO Baoying;WANG Yaojie;ZHANG Hua;YANG Haibo;LI Youjin(Department of Cardiac and Vascular Surgery,People’s Hospital of Ningxia Hui Autonomous Region,Yinchuan 750002,China)

机构地区：[1]宁夏回族自治区人民医院心血管中心,宁夏银川750002

出　　处：《宁夏医学杂志》2022年第12期1067-1070,共4页Ningxia Medical Journal

基　　金：宁夏回族自治区科技支撑项目(CWYSCB025)。

摘　　要：目的 对比高龄急性Stanford A型主动脉夹层外科手术治疗与保守治疗的临床效果。方法 选取收治的年龄≥65岁的急性Stanford A型主动脉夹层患者29例,其中自愿选择外科手术治疗16例,自愿选择保守治疗13例;外科手术患者中急诊手术14例(87.50%),限期手术2例(12.50%)。累及弓部的手术均在深低温停循环+选择性脑灌注下完成,包括bentall手术和单纯升主动脉置换术,弓部手术方式分为部分主动脉弓置换术、经典孙氏手术。保守治疗患者常规给予降压、止痛、降心率等药物治疗,观察2种治疗方法患者的死亡率、并发症、住院费用及远期疗效随访情况等。结果 2组患者死亡16例,其中手术组死亡5例(31.25%),非手术组死亡11例(84.62%);手术组患者围术期并发症为多脏器功能衰竭5例(31.25%),脓毒症伴脓毒性休克3例(18.75%),急性肾损伤5例(31.25%),下肢血栓4例(25.00%),中枢神经系统6例(37.50%),急性呼吸窘迫综合征6例(37.50%),房颤伴快速心室率8例(50.00%),胸骨切口裂开2例(12.50%),肺栓塞1例(6.25%)。手术组住院费用(27.5±8.8)万元,非手术组为(1.44±0.8)万元。结论 高龄急性Stanford A型主动脉夹层患者在排除手术禁忌后应积极进行外科手术,手术存活率高于保守治疗。Objective To compare the clinical effect of conservative treatment and surgical treatment in acute stanford type A aortic dissection in the elderly.Methods 29 patients(≥65 years old) with acute Stanford type A aortic dissection were selected, including 16 patients who were willing to choose surgical operation and 13 patients who were willing to choose conservative treatment. Emergency operation was performed in 14 cases(87.50%) and limited operation were underwent in 2 cases(12.50%). The operations involving the arch were performed under deep hypothermic circulatory arrest and selective cerebral perfusion, including Bentall operation and simple ascending aorta replacement. The arch operations were divided into partial aortic arch replacement and classic sun′s operation. The patients with conservative treatment were routinely treated with antihypertensive, analgesic, heart rate lowering medicine. The mortality, complications, hospitalization expenses and long-term efficacy of the two methods were observed.Results There were 16 dead cases in the two groups, including 5 cases in the operative group(31.25%) and 11 cases in the non-operative group(84.62%). The patients in the operation group had perioperative complications, including 5 cases(31.25%) of multiple organ failure, 3 cases(18.75%) of sepsis with septic shock, 5 cases(31.25%) of acute renal injury, 4 cases(25.00%) of lower limb thrombosis, 6 cases(37.50%) of central nervous system complications, 6 cases(37.50%) of acute respiratory distress syndrome, 8 cases(50.00%) of atrial fibrillation with rapid ventricular rate, 2 cases(12.50%) of sternal incision dehiscence, and 1 case(6.25%) of pulmonary embolism. The hospitalization expenses of the operation group were(275 000±88 000)yuan, the hospitalization expenses of non-operation group(14 400±8 000) yuan.Conclusion The elderly patients with acute Stanford type A aortic dissection should be performed surgery after the exclusion of surgical contraindications. The survival rate of the operation is significant

关 键 词：主动脉夹层 急性Stanford A型 高龄 外科手术 保守治疗 

分 类 号：R654.3[医药卫生—外科学]