合并冠状动脉灌注不良的急性A型主动脉夹层的外科治疗  

Surgical Management of Acute Type A Aortic Dissection with Coronary Malperfusion

作　　者：董书强 曹文峰 谢鹏禄 张兆喻 张羽 杨凯 闵凯 郝涛 刘思达 DONG Shuqiang;CAO Wenfeng;XIE Penglu;ZHANG Zhaoyu;ZHANG Yu;YANG Kai;MIN Kai;HAOTao;LIU Sida(Department of Cardiovascular Surgery,the 940th Hospital of Joint Logistic Support Force of PLA,Lanzhou,Gansu 730050,China)

机构地区：[1]解放军联勤保障部队第940医院心血管外科,兰州730050

出　　处：《岭南心血管病杂志》2023年第4期375-379,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的总结合并冠状动脉灌注不良急性A型主动脉夹层患者13年的治疗经验。方法回顾性分析2008年1月到2020年12月解放军联勤保障部队第940医院手术治疗的合并冠状动脉灌注不良急性A型主动脉夹层患者17例的临床资料,其中男15例、女2例,年龄(51.2±11.2)岁,右冠状动脉受累10例(58.8%),左冠状动脉受累3例(17.6%),左右冠状动脉均受累4例(23.5%);Neri A型5例(29.4%)、B型9例(52.9%)、C型3例(17.7%)。所有患者均在急诊全身麻醉下中度/深度低温下进行手术治疗。结果11个冠状动脉开口缝合或补片修复,8根冠状动脉旁路移植,术后30 d死亡4例(病死率为23.5%):术中不能脱离体外循环机2例,术后低心排血量综合征1例、脓毒性休克合并多脏器功能衰竭1例。随访3~141个月,2例患者死亡,1例需再次手术。结论合并冠状动脉灌注不良的急性A型主动脉夹层患者的手术死亡率依然很高,需要及时明确诊断和手术治疗,根据冠状动脉受累类型,个体化采取冠状动脉修复或旁路移植策略,有效恢复心肌供血是成功救治的关键。Objectives To summarize the 13 years of treatment experience in patients with acute type A aortic dissection(ATAAD)complicated with coronary malperfusion.Methods Clinical data of 17 ATAAD patients with coronary malper⁃fusion in the 940th Hospital of Joint Logistic Support Force of PLA between January 2008 and September 2020 were retro⁃spectivly analized.Among them,15 patients were men,2 patients were women and the mean age were(51.2±11.2)years.The right coronary artery was involved in 10 patients,the left coronary artery was involved in 3 patients,and both coronary arteries were involved in 4 patients.All the patients underwent emergency operation under general anesthesia and moderate or deep hypothermic circulatory arrest.Results Eleven coronary ostiums or ostial buttons were repaired with a continuous suture or patch.Eight coronary arteries were bypassed by great saphenous vein.Hospital mortality rate was 23.5%(4 of 17 patients).Of these,2 patients could not be weaned from cardiopulmonary bypass and died intraoperatively,1 patient died of postoperative low cardiac output syndrome,and 1 patient died of multiorgan failure associated with septic shock.Conclusions ATAAD patients with coronary malperfusion have high mortality rates.These patients need early diagnosis and promptly operation.The vital factor is to reestablish an adequate coronary blood flow by individual surgical strategy including coronary bypass grafting or repair of coronary vessels.

关 键 词：主动脉夹层 冠状动脉 灌注不良 

分 类 号：R654.1[医药卫生—外科学]