不同时机Castor分支支架治疗B型主动脉夹层的疗效及对炎症反应、机体应激、凝血功能的影响  

The efficacy of different timing Castor branch stents in the treatment of type B aortic dissection and their effects on inflammatory response,body stress,and coagulation function

作　　者：林芳明 薛海龙 柯俊丞 张辛 林明冠 LIN Fangming;XUE Hailong;KE Juncheng;ZHANG Xin;LIN Mingguan(Department of Vascular Surgery,Haikou People's Hospital,Haikou,Hainan,China,570208)

机构地区：[1]海口市人民医院血管外科,海南海口570208

出　　处：《分子诊断与治疗杂志》2024年第9期1674-1677,1682,共5页Journal of Molecular Diagnostics and Therapy

基　　金：海南省自然科学基金高层次人才项目(821RC1142)。

摘　　要：目的研究不同时机Castor分支支架治疗B型主动脉夹层(TBAD)的疗效及对炎症反应、机体应激、凝血功能的影响。方法选择2021年1月至2023年12月于海口市人民医院进行治疗的TBAD患者82例,依据手术时机分为急性期组(n=40)、亚急性期组(n=42),急性期组于急性期内行Castor分支支架治疗,亚急性期组于亚急性期内行Castor分支支架治疗。观察两组术前、术后90 d主动脉重塑指标。观察两组术前、术后7 d血清炎症介质、血浆机体应激介质及凝血功能指标。统计两组术后并发症情况。结果术后90 d,急性期组最小真腔直径大于亚急性期组,最大假腔直径小于亚急性期组,差异有统计学意义(P<0.05)。术后7 d,急性期组血清IL-6、hs-CRP、TNF-α均低于亚急性期组,差异有统计学意义(P<0.05)。术后7 d,急性期组ACTH、Cor均低于亚急性期组,差异有统计学意义(P<0.05)。术后7 d,急性期组FDP、D-D均低于亚急性期组,差异有统计学意义(P<0.05)。两组术后并发症发生率比较差异无统计学意义(P>0.05)。结论TBAD急性期行Castor分支支架治疗可有效封堵破口,促进主动脉重塑,缓解炎症反应、机体应激,改善凝血功能,且安全性较高。Objective To study the efficacy of different timing Castor branch stents in the treatment of type B aortic dissection(TBAD)and their effects on inflammatory response,body stress,and coagulation function.Methods A total of 82 TBAD patients treated in Haikou People's Hospital from January 2021 to December 2023 were included in the acute stage group(n=40)and the subacute stage group(n=42),respectively,according to the timing of surgery.The acute stage group received Castor branch stenting during the acute stage,and the subacute stage group received Castor branch stenting during the subacute stage.The indexes of aortic remodeling before and 90 days after operation were observed.Serum inflammatory mediators,plasma body stress mediators and coagulation function indexes were observed before and 7 d after operation.The postoperative complications of the two groups were analyzed.Results 90 d after operation,the minimum true cavity diameter in the acute stage group was larger than that in the subacute stage group,and the maximum false cavity diameter was smaller than that in the subacute stage group,the difference was statistically significant(P<0.05).On 7 d after surgery,serum IL-6,hs-CRP and TNF-alpha in the acute stage group were lower than those in the subacute stage group,and the difference was statistically significant(P<0.05).7 d after surgery,ACTH and Cor in the acute stage group were lower than those in the subacute stage group,and the difference was statistically significant(P<0.05).7 d after surgery,FDP and D-D in the acute stage group were lower than those in the subacute stage group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of postoperative complications between the two groups(P>0.05).Conclusion Castor branch stent treatment in acute stage of TBAD can effectively seal the rupture,promote aortic remodeling,relieve inflammation and body stress,and improve coagulation function,and relatively safe.

关 键 词：时机 Castor分支支架 B型主动脉夹层 炎症反应 机体应激 凝血功能 

分 类 号：R654.2[医药卫生—外科学]