急性Stanford B型主动脉夹层患者行胸主动脉腔内修复术中部分覆盖左锁骨下动脉临床效果分析  

Clinical analysis of partial coverage of the left subclavian artery during thoracic endovascular aortic repair in patients with acute type B aortic dissection

作　　者：经子兰 张志强 周铁楠 荆全民 王效增 JING Zi-lan;ZHANG Zhi-qiang;ZHOU Tie-nan;JING Quan-min;WANG Xiao-zeng(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北部战区总医院心血管内科,辽宁沈阳110016

出　　处：《临床军医杂志》2023年第5期493-498,共6页Clinical Journal of Medical Officers

基　　金：辽宁省“兴辽英才计划”资助项目(XLYC2008004)。

摘　　要：目的分析急性Stanford B型主动脉夹层(TBAD)患者行胸主动脉腔内修复术(TEVAR)中部分覆盖左锁骨下动脉的临床效果及安全性。方法回顾性分析北部战区总医院自2007年6月至2021年4月收治的经计算机断层扫描血管造影明确诊断为急性TBAD并行TEVAR的819例患者的临床资料。根据术中是否覆盖左锁骨下动脉,将患者分为部分覆盖组(n=232)和未覆盖组(n=587)。比较两组患者的基线资料和影像学特征,以及住院和随访期间的临床不良事件发生率。所有患者在出院后30 d、1年接受随访,随访内容包括主动脉相关不良事件、全因死亡、新发脑卒中、左上肢缺血等情况。结果部分覆盖组患者年龄、D⁃二聚体水平均低于未覆盖组,螺旋形撕裂比例高于未覆盖组,差异有统计学意义(P<0.05)。住院期间,两组患者共死亡9例,其中,部分覆盖组4例,未覆盖组5例。部分覆盖组左上肢乏力、左上肢疼痛、左上肢苍白和发凉的发生率均高于未覆盖组,差异有统计学意义(P<0.05)。30 d时,部分覆盖组212例完成随访,随访率为92.98%(212/228);未覆盖组534例完成随访,随访率为91.75%(534/582)。两组共死亡7例:部分覆盖组1例,未覆盖组6例。两组患者全因死亡、新发脑卒中、左上肢缺血、主动脉相关不良事件等临床不良事件发生率比较,差异均无统计学意义(P>0.05)。对810例存活出院患者进行1年随访,共随访670例(82.72%):部分覆盖组188例完成随访,随访率为82.46%(188/228);未覆盖组482例完成随访,随访率为82.82%(482/582)。部分覆盖组全因死亡、心源性死亡的发生率低于未覆盖组,差异有统计学意义(P<0.05)。两组患者新发脑卒中、左上肢缺血、主动脉相关不良事件等临床不良事件发生率比较,差异均无统计学意义(P>0.05)。结论在严格把握适应证的前提下,采用部分覆盖左锁骨下动脉开口的TEVAR治疗近端锚定区不充足的急性TBAD患者,�Objective To analyze the clinical effect and safety of partial coverage of the left subclavian artery in thoracic endovascular aortic repair(TEVAR)in patients with acute type B aortic dissection(TBAD).Methods The clinical data of 819 patients diagnosed with acute TBAD and TEVAR by computed tomography angiography admitted to General Hospital of Northern Theater Command from June 2007 to April 2021 were retrospectively analyzed.Patients were divided into partially covered group(n=232)and uncovered group(n=587)based on whether the left subclavian artery was covered during surgery.Baseline data and imaging characteristics,as well as the incidence of clinical adverse events during hospitalization and follow⁃up were compared between the two groups.All patients were followed up 30 days and 1 year after discharge.The follow⁃up included aortic related adverse events,all⁃cause death,new stroke,and left upper limb ischemia.Results The age and D⁃dimer level of partially covered group were lower than those of uncovered group,and the proportion of spiral tear was higher than that of uncovered group,with statistical significance(P<0.05).During hospi⁃talization,a total of 9 patients died in both groups,including 4 in the partially covered group and 5 in the uncovered group.The inci⁃dence of left upper limb weakness,left upper limb pain,left upper limb pallor and chilling in partially covered group was higher than that in uncovered group,and the difference was statistically significant(P<0.05).At 30 days,212 patients in the partially covered group had completed the follow⁃up,and the follow⁃up rate was 92.98%(212/228).The follow⁃up of 534 patients in the uncovered group was completed,and the follow⁃up rate was 91.75%(534/582).A total of 7 deaths occurred in the two groups:1 in the partially covered group and 6 in the uncovered group.There were no significant differences in the incidence of all⁃cause death,new stroke,left upper limb ischemia,aorta related adverse events between two groups(P>0.05).A total of 81

关 键 词：急性Stanford B型主动脉夹层 胸主动脉腔内修复术 近端锚定区 部分覆盖左锁骨下动脉开口 并发症 

分 类 号：R54[医药卫生—心血管疾病]