预置包裹法对凝血功能异常的A型主动脉夹层手术的止血效果分析  

Analysis of hemostatic effect of preset wrapping technique on Type A aortic dissection with abnormal coagulation

作　　者：蔡治祥 颜涛 罗林 张卫达 陈汉威 王显悦 CAI Zhiciang;YAN Tao;LUO Lin;ZHANG Weida;CHEN Hanwei;WANG Xianyue(General Hospital of Southern Theatre Command of PLA,Guangzhou,510010,China;Guangzhou Panyu Central Hospital)

机构地区：[1]中国人民解放军南部战区总医院,广州510010 [2]广州市番禺区中心医院

出　　处：《临床心血管病杂志》2023年第6期438-443,共6页Journal of Clinical Cardiology

基　　金：国家自然科学基金委员会资助项目-海外及港澳门学者合作项目(No:81729003);番禺区科技计划项目(No:2019-Z04-84);广东省医学科学技术研究基金项目(No:C2022135)

摘　　要：目的:探讨采用预置牛心包包裹-右心分流法对伴凝血功能异常的A型主动脉夹层(AAD)手术的止血效果及早期疗效。方法:回顾性分析2018年1月—2022年9月于南部战区总医院心脏外科中心行全弓置换手术的患者399例,术前伴凝血功能异常AAD患者78例,根据术前是否采用预置牛心包包裹法止血进行分组,其中预置包裹组23例,对照组55例。全组内科凝血异常治疗策略参考美国2017 EACTS/EACTA(成人心脏手术患者血液管理指南)对症治疗,预置组均采用预置牛心包包裹-右心分流法止血,对照组止血先尝试主动脉人工血管“裸奔”,必要时加牛心包或自体心包补片包裹分流止血。比较分析两组患者术前一般资料及凝血异常指标情况、手术情况、输血量及凝血药物使用情况及术后早期恢复情况。结果:全组AAD伴凝血功能异常患者均完成外科手术操作。①术前情况:两组患者年龄、发病时间、高血压例数、肝功能异常情况及凝血相关异常指标无明显差异;②术中情况:两组行Bentall术(带主动脉瓣人工血管升主动脉替换术)、心脏停搏时间无明显统计学差异,与对照组相比,预置组体外循环时间[(291.5±56.8) min vs (223.7±45.3) min,P<0.001]、手术时间较短[(495.5±81.3) min vs (380.6±65.8) min,P<0.001];③输血量及凝血药物使用情况:与对照组相比,预置组输注血液制品(浓缩红细胞、新鲜冰冻血浆和血小板)及使用凝血相关药物(凝血酶原复合物、纤维蛋白原和重组人凝血七因子较少)(P<0.05);④术后恢复情况:与对照组比较,预置组患者术后24 h纵隔引流量较少、ICU留滞时间较短(P<0.05),院内死亡例数、机械通气时间、再次开胸止血、纵隔感染例数、床旁血滤治疗例数减少,但无统计学差异(P>0.05)。结论:预置牛心包包裹止血法应用于伴凝血功能异常的AAD手术基本不增加主动脉阻壁时间,可减少体外循环辅助时间�Objective: To explore the hemostatic effect and early clinical effect of bovine pericardium wrapping-right atrial shunt for type A aortic dissection(AAD) with abnormal coagulation before operation. Methods: A total of 399 AAD patients who underwent total arch replacement in the Cardiac Surgery Center of General Hospital of Southern Theater Command from January 2018 to September 2022 were retrospectively analyzed, and 78 patients with preoperative coagulation dysfunction were enrolled and divided into preset bovine pericardium wrapping group(n=23) and control group(n=55). All patients treatment strategy for internal coagulation abnormalities was based on the results of blood coagulation function, and by referring to the 2017 EACTS/EACTA(Guidelines for Blood Management of Adult Heart Surgery Patients) of the United States for symptomatic treatment, All patients in the preset group were treated with preset bovine pericardium wrapped and right heart shunt to prevent or decrease bleeding, while the control group was first tried to artificial aortic vessels "streak-running", and bovine pericardium or autologous pericardium patch was wrapped and shunt to prevent or decrease bleeding if necessary. The preoperative general data, abnormal coagulation indicators, surgical conditions, blood transfusion volume, coagulation drug use, and early postoperative recovery of the two groups were compared and analyzed. Results: All AAD patients completed surgical procedures.①Preoperative conditions: There was no significant difference between the two groups in age, onset time, number of hypertension cases, abnormal liver function and coagulation related abnormal indicators;②Intraoperative conditions: There was no significant difference between the two groups in the proportion of Bentall operation and cardiac arrest time(P>0.05). Compared with the control group, preset pericardium group had shorter the time of cardiopulmonary bypass and operation(P<0.001);③Blood transfusion volume and use of coagulation drugs: compared with the c

关 键 词：A型主动脉夹层 凝血功能异常 牛心包预置包裹 止血 

分 类 号：R544[医药卫生—心血管疾病]