主动脉全弓置换对机体心率和血压的影响  

Impact of total aortic arch replacement on heart rate and blood pressure

作　　者：张金周 张红 移康[1] 周倩倩 高军龙 Zhang Jinzhou;Zhang Hong;Yi Kang;Zhou Qianqian;Gao Junlong(Department of Critical Care Medicine,Cardiac Surgery Department,Gansu Provincial People's Hospital,Lanzhou,Gansu,730000,China)

机构地区：[1]甘肃省人民医院急诊重症医学科心外科,甘肃兰州730000

出　　处：《齐齐哈尔医学院学报》2024年第20期1946-1950,共5页Journal of Qiqihar Medical University

摘　　要：目的观察Stanford A型主动脉夹层患者行主动脉弓置换术后对心率和血压的影响。方法回顾性分析2020年1月—2022年12月本院ICU收治的120例施行主动脉弓置换术的Stanford A型主动脉夹层患者围术期的临床资料,分为观察组1和观察组2共两组,每组各60例。将施行Bentall手术(带主动脉瓣人工血管升主动脉置换术)者设为观察组1,施行sun氏手术(主动脉全弓人工血管置换+远端支架植入象鼻术)者设为观察组2,两组患者术后均全程持续监测生命体征及纵膈引流量,常规施行镇痛镇静治疗,术后24 h内呼吸机辅助通气及补液、预防感染治疗。分别观察术前12 h,以及术后30 min、2 h、4 h、8 h、12 h、24 h、72 h和第28天患者心率和血压的变化以及血管活性药物使用剂量的差异。结果较术前相比,两组患者术后28 d收缩压均明显低于术前12 h(P<0.05),术后舒张压与术前对比无明显差异(P>0.05);术后两组患者各个时间点血压变化无差异(P>0.05);两组患者术后心率较术前明显增快,组内对照发现,无论是术后72 h内还是术后28 d观察组2心率明显高于观察组1(P<0.05);在血管活性药物使用方面,两组患者在8 h、12 h、24 h的多巴胺使用量对比均具有明显差异(P<0.05),且观察组1多巴胺使用剂量明显低于观察组2(P<0.05),但是两组在48 h和72 h后使用剂量水平接近,差异无统计学意义(P>0.05),在围术期肾上腺素、去甲肾上腺素、硝酸甘油的使用剂量两组患者无明显差异(P>0.05)。结论施行升主动脉置换术的患者,机体收缩压较术前相比会有显著下降,舒张压变化不明显;在失去主动脉弓压力感受器的反馈调节后,机体的心率会有明显的增快。Objective To observe the effect of total aortic arch replacement on heart rate and blood pressure in patients with Stanford type A aortic dissection.Methods The perioperative clinical data of patients with Stanford type A aortic dissection who underwent total aortic arch replacement in the ICU of Gansu Provincial People's Hospital from January 2020 to December 2022 were retrospectively analyzed.They were divided into observation group 1 and observation group 2,with 60 patients in each group.The patients who underwent the Bentall procedure(replacement of the ascending aorta with the aortic valve prosthetic vessel)were enrolled in observation group 1,and the patients who underwent Sun's procedure(total aortic arch replacement with a vascular graft and distal stent implantation of the elephant trunk)were enrolled in observation group 2.Patients in both groups were continuously monitored for vital signs and mediastinal drainage during the whole postoperative period,along with routine analgesic and sedative treatment,as well as ventilator-assisted ventilation within 24 hours after surgery and fluid replacement and infection prevention treatment in the early stage.The changes in heart rate and blood pressure of the patients,as well as the dose of vasoactive drugs,were observed at 12 hours before the operation,and 30 minutes,2 hours,4 hours,8 hours,12 hours,24 hours,72 hours,and 28 days after the operation.Results Compared with preoperative values,the systolic pressure of the two groups of patients at 28 days after the operation was significantly lower than that at 12 hours before the operation(P<0.05).The diastolic pressure after the operation was not significantly different from that before the operation(P>0.05).There were no significant differences in blood pressure changes at each time point between the two groups of patients after the operation(P>0.05).The heart rate of patients in both groups increased significantly after surgery.Intra-group control found that the heart rate of observation group 2 was significantl

关 键 词：主动脉弓压力感受器 主动脉夹层 主动脉弓置换 血压 心率 

分 类 号：R543[医药卫生—心血管疾病]