优先吻合主动脉弓分支的全弓置换加支架象鼻术治疗Stanford A型主动脉夹层的有效性和安全性研究  

Effectiveness and safety of total arch replacement with selective brain perfusion and stented elephant trunk technique with priority anastomosis of the aortic arch branches in the treatment of stanford type A aortic dissection

作　　者：李兴 贾亚男 王雪霞 郭立新 LI Xing;JIA Ya-nan;WANG Xue-xia;GUO Li-xin(Cardiac Vascular Surgery,Xingtai Central Hospital,Xingtai 054000,China)

机构地区：[1]邢台市中心医院心脏大血管外科,河北省邢台市054000

出　　处：《中国心血管病研究》2024年第9期847-852,共6页Chinese Journal of Cardiovascular Research

基　　金：邢台市重点研发计划项目(2023ZZ054)。

摘　　要：目的 分析优先吻合主动脉弓分支的全弓置换加支架象鼻术治疗Stanford A型主动脉夹层的有效性和安全性。方法 选择2020年8月至2023年5月间邢台市中心医院收治的100例Stanford A型主动脉夹层患者,依照随机信封法分为观察组和对照组各50例,观察组采用优先吻合主动脉弓分支的全弓置换加支架象鼻术治疗,对照组患者采用常规三明治技术行主动脉根部重建术治疗。详细记录体外循环时间,主动脉阻断时间,停循环时间,术后呼吸机使用时间,主动脉窦部直径,主动脉瓣反流量。并详细记录患者并发症、死亡情况,治疗前后检测患者血中D二聚体(D-D)及C反应蛋白(CRP)水平;随访一年并评估康复情况。结果 观察组主动脉阻断时间[(105.84±17.74)min比(123.81±11.28)min]、术后主动脉窦部直径[(35.03±1.82)mm比(37.42±2.01)mm]、停循环时间[(20.31±3.85)min比(24.78±3.25)min]、术后呼吸机使用时间[(66.58±8.89)h比(73.43±9.87)h]、体外循环时间[(201.21±18.93)min比(218.78±21.09)min]、主动脉瓣反流量[(0.64±0.21)cm^(3)比(1.12±0.26)cm^(3)]、血中D-D[(0.31±0.08)μg/L比(0.67±0.12)μg/L]及CRP[(7.03±1.05)μg/L比(9.29±1.15)μg/L]均明显低于对照组,且差异存在统计学意义(P<0.05);两组患者二次开胸止血、血液透析、气管切开、神经系统并发症等发生率、病死率无明显差异(P>0.05)。术后半年时除死亡者外,其余患者治疗一年后心功能均为Ⅰ~Ⅱ级。结论 优先吻合主动脉弓分支的全弓置换加支架象鼻术在治疗Stanford A型主动脉夹层时可有效改善患者手术操作技术、心脏保护、术后恢复和术后炎症凝血的控制。Objective To analyze the effectiveness and safety of total arch replacement with selective brain perfusion and stented elephant trunk technique with priority anastomosis of the aortic arch branches in the treatment of Stanford Type A aortic dissection.Methods 100 patients with Stanford type A aortic dissection admitted to Xingtai Central Hospital from August 2020 to May 2023 were selected and divided into the observation group and control group according to the random envelope method,each with 50 cases.The observation group was treated with total arch replacement with stenting and elephant nose operation with preferential anastomosis to the branches of the aortic arch,and the patients in the control group were treated with aortic root reconstruction using the conventional sandwich technique.The time of extracorporeal circulation,the time of aortic block,the time of stopping circulation,the time of postoperative ventilator use,the diameter of the aortic sinus section and the amount of aortic valve regurgitation were recorded in detail.Complications and deaths were also recorded in detail,and the blood levels of D-dimer(D-D)and C-reactive protein(CRP)were measured before and after the treatment.The patients were followed up for one year and their recovery was assessed.Results In the observation group,the aortic block time[(105.84±17.74)min vs.(123.81±11.28)min],postoperative aortic sinus diameter[(35.03±1.82)mm vs.(37.42±2.01)mm],time to circulatory arrest[(20.31±3.85)min vs.(24.78±3.25)min],postoperative ventilator use time[(66.58±8.89)h vs.(73.43±9.87)h],extracorporeal circulation time[(201.21±18.93)min vs.(218.78±21.09)min],aortic regurgitant flow rate[(0.64±0.21)cm3 vs.(1.12±0.26)cm3],blood D-D[(0.31±0.08)μg/L vs.(0.67±0.12)μg/L],and CRP[(7.03±1.05)μg/L vs.(9.29±1.15)μg/L]were significantly lower than those in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of secondary open-heart haemostasis,haemodialysis,trache

关 键 词：优先吻合主动脉弓分支 全弓置换 支架象鼻术 Stanford A型主动脉夹层 有效性 安全性 

分 类 号：R543.1[医药卫生—心血管疾病]