胸骨上段单一小切口行主动脉夹层手术对患者围术期呼吸功能的影响  

Impact of aortic dissection surgery through a single small incision in the upper sternum on the perioperative respiratory function of patients

作　　者：刘秩硕 夏麟 王璐 孙彪 杨忠路 葛玉光 姜辉 LIU Zhi-shuo;XIA Lin;WANG Lu;SUN Biao;YANG Zhong-lu;GE Yu-guang;JIANG Hui(Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang 110116,China)

机构地区：[1]北部战区总医院心血管外科,辽宁沈阳110016

出　　处：《创伤与急危重病医学》2024年第6期348-351,356,共5页Trauma and Critical Care Medicine

摘　　要：目的对比胸骨上段单一小切口与传统正中切口行Stanford A型主动脉夹层手术与对患者围术期呼吸功能的影响。方法选取2020年8月至2022年2月北部战区总医院收治的113例急性Stanford A型主动脉夹层(ATAAD)患者,男性78例,女性35例,年龄(51.33±10.91)岁,年龄范围为21~72岁。根据手术切口区别将患者分为小切口组(n=68)和正中切口组(n=45)。均由同一手术小组完成全主动脉弓置换术联合冰冻象鼻支架植入术。对两组患者的术中指标、围术期指标、呼吸指标、疼痛程度进行统计分析。结果小切口组患者的术中出血量低于正中切口组,差异有统计学意义(P<0.05)。两组患者的输血情况、术后24 h引流量、拔除引流管时间、切口愈合不良比较,差异有统计学意义(P<0.05)。两组患者二次气管插管、术后第5天氧合指数比较,差异有统计学意义(P<0.05)。两组患者术后第1天、术后第3天、术后第7天的疼痛数字评定量表评分比较,差异有统计学意义(P<0.05)。结论胸骨上段小切口行全主动脉弓置换术联合冰冻象鼻支架植入术安全有效,可以降低出血量、输血量、引流量、切口愈合不良发生率,改善术后氧合指数及减轻疼痛。Objective To explore the impact on perioperative respiratory function of patients when applying a single small incision in the upper sternum for aortic dissection surgery compared with the traditional median sternotomy.Methods A total of 113 patients with acute Stanford type A aortic dissection who underwent total aortic arch replacement combined with frozen elephant trunk implantation by the same surgical team at the Northern Theater General Hospital from August 2020 to February 2022 were selected as the study subjects.Patients were divided into a small incision group with 68 cases and a median sternotomy group with 45 cases.The general clinical data,perioperative conditions postoperative respiratory function-related indexes and pain scores of the 2 groups were statistically analyzed.Results Compared with patients with median sternotomy group patients in the small incision group had reduced intraoperative bleeding and blood transfusion,less 24-hour postoperative drainage,shorter indwelling drains,and lower incidence of sternal doodads(P<0.05).The lower rates of reintubation and higher oxygenation index on the fifth day after surgery in patients in the small incision group(P<0.05).Additionally,patients in the small incision group had lower pain scores on the first,third,and seventh days after surgery than patients in the median sternotomy group(P<0.05).Conclusion The small incision in the upper sternum for total aortic arch replacement combined with frozen elephant trunk implantation shows safe and effective reduces bleeding,blood transfusion,drainage volume,incidence of poor incision healing,improves the postoperative oxygenation index and reduces pain as a means to protect and improve respiratory function.

关 键 词：胸骨上段小切口 主动脉夹层 全主动脉弓置换术 冰冻象鼻支架植入术 呼吸功能 数字评定量表 

分 类 号：R654[医药卫生—外科学]