急性Stanford A型主动脉夹层孙氏手术中左颈总动脉联合股动脉插管的应用效果及患者术后早期死亡的危险因素分析  

Application effect of left common carotid artery combined with femoral artery cannulation in Sun's surgery for acute Stanford type A aortic dissection and analysis of the early postoperative mortality risk factors

作　　者：王元博 冯俊波[1] 胡运涛[1] 董文鹏 彭鹏 李俊涛 刘健良 葛圣林[1] 林敏[1] Wang Yuanbo;Feng Junbo;Hu Yuntao;Dong Wenpeng;Peng Peng;Li Juntao;Liu Jianliang;Ge Shenglin;Lin Min(Department of Cardiovascular Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院心脏大血管外科,合肥230022

出　　处：《中华解剖与临床杂志》2024年第8期538-545,共8页Chinese Journal of Anatomy and Clinics

摘　　要：目的:探讨左颈总动脉联合股动脉插管方式在急性Stanford A型主动脉夹层患者孙氏手术中的应用效果,以及孙氏手术患者术后早期死亡的影响因素。方法:回顾性队列研究。纳入2017年1月—2022年6月安徽医科大学第一附属医院心脏大血管外科急性Stanford A型主动脉夹层患者132例,其中男94例、女38例,年龄26~79(52.9±12.1)岁。患者均行孙氏手术即主动脉根部重建(置换)+升主动脉置换+全主动脉弓人工血管置换并象鼻支架置入术,按照术中插管方式分为2组:82例采用左颈总动脉联合股动脉插管者为观察组,其中男58例、女24例,年龄29~79(52.8±12.4)岁;50例术中采用腋动脉联合股动脉插管者为对照组,其中男36例、女14例,年龄26~75(53.2±11.5)岁。观察指标:(1)比较2组患者基线资料;(2)对比2组患者围术期指标及并发症发生率;(3)按照患者出院情况分为正常出院组和早期死亡组,对2组患者的基线资料、围手术期观察指标及并发症发生率进行单因素分析,筛选出P<0.10的指标进行多因素logistic回归分析,分析患者孙氏手术后早期死亡的影响因素。结果:所有患者手术顺利。(1)2组患者在性别、年龄、体质量指数、合并症发生率、中重度主瓣反流、肌酐、弓部受累情况等基线资料比较,差异均无统计学意义(P值均>0.05)。(2)观察组的总手术时间、建立体外循环时间、停循环时间、术后麻醉清醒时间、机械通气时间、重症监护室留观时间、术后住院时间、术后第一次乳酸值分别为(499.9±74.4)min、93.0(80.8,113.5)min、26.0(25.0,31.0)min、3.6(2.3,6.3)h、22.5(14.0,57.3)h、3(2,6)d、16(13,21)d、2.9(1.9,4.7)mmol/L,均少于对照组的(570.8±94.6)min、109.0(95.8,130.0)min、38.0(27.8,52.0)min、6.0(4.3,11.8)h、75.5(24.0,116.3)h、7(5,11)d、22(16,29)d、5.1(2.0,10.0)mmol/L,差异均有统计学意义(P值均<0.05);观察组和对照组的主动脉根部处理方式(根部成型术、WhObjective This study aimed to explore the application effect of the left carotid combined with femoral cannulation in Sun's surgery for acute Stanford type A aortic dissection and to analyze the risk factors affecting early postoperative mortality.Methods This cohort study included 132 patients with acute Stanford type A aortic dissection diagnosed in the Department of Cardiovascular Surgery,the First Affiliated Hospital of Anhui Medical University from January 2017 to June 2022.Among them,94 were males and 38 were females aged 26-79(52.9±12.1)years.All patients underwent simultaneous aortic root reconstruction(replacement),ascending aortic replacement,total aortic arch artificial vessel replacement,and stent elephant-nose placement surgery(Sun's surgery).They were divided into two groups according to the intraoperative intubation method.The first group was the observation group,which comprised 82 patients treated with left carotid combined femoral artery cannulation.They were 58 males and 24 females aged 29-79(52.8±12.4)years.The second group served as the control group.which included 50 patients who underwent axillary artery combined with femoral artery cannulation during surgery.They were 36 males and 14 females aged 26-75(53.2±11.5)years old.The observation indicators were as follows.(1)Baseline data were compared between two groups of patients.(2)The perioperative indicators and incidence of complications were compared between the two groups of patients.(3)We divided patients into normal discharge group and early death group according to their discharge status.Single-factor analysis was conducted on the baseline data,perioperative clinical data,and incidence of complications of the two groups of patients.Multivariate logistic-regression analysis was performed on indicators with P<0.10.The factors influencing early postoperative death in Sun's surgery were analyzed.Results All patients underwent surgery successfully.(1)No statistically significant difference existed between the two groups of patients in ba

关 键 词：主动脉疾病 主动脉夹层 全主动脉弓置换 象鼻支架置入术 左颈总联合股动脉插管 腋动脉联合股动脉插管 

分 类 号：R654.3[医药卫生—外科学]