单中心急性B型主动脉夹层患者行急诊胸主动脉腔内修复术近远期疗效分析  

Analysis of the near and far-term effects of emergency thoracic endovascular aortic repair in patients with actue type B aortic dissection at a single center

作　　者：李娜 刘金新 赵庭浩 张志强 周铁楠 孙东源 王效增 LI Na;LIU Jin-xin;ZHAO Ting-hao;ZHANG Zhi-qiang;ZHOU Tie-nan;SUN Dong-yuan;WANG Xiao-zeng(Department of Cardiology,General Hospital of Northern Theater Command,Shenyang 110016,China;Department of Cardiology,PLA 32183 Unit Hospital,Baicheng 137000,China)

机构地区：[1]北部战区总医院心血管内科,辽宁沈阳110016 [2]解放军32183部队医院心血管内科,吉林白城137000

出　　处：《临床军医杂志》2024年第12期1223-1225,1230,共4页Clinical Journal of Medical Officers

基　　金：辽宁省“兴辽英才计划”资助项目(XLYC2008004)。

摘　　要：目的分析急性B型主动脉夹层(ATBAD)患者行急诊胸主动脉腔内修复术(TEVAR)的近远期疗效。方法回顾性分析北部战区总医院自2010年1月至2022年12月收治的明确诊断为ATBAD且入院至行TEVAR时间<24 h的72例患者的临床资料,包括基线资料、手术情况及术后随访情况。结果46例患者术中无死亡,即刻手术成功率为100.0%(46/46)。术中发生Ⅰ型内漏1例;术后住院期间死亡3例,2例死因为主动脉破裂,1例为多脏器衰竭。在出院至术后30 d的近期随访中,无患者死亡或发生主动脉相关不良事件。远期随访平均(36.6±26.1)个月。2例患者死亡,其中,1例死因为主动脉破裂,发生在出院后第66天,另1例死因为心力衰竭,发生在出院后的第12个月;6例患者出现主动脉相关不良事件,其中,1例为主动脉源性死亡,1例为逆行A型主动脉夹层,3例新发内漏,1例因发生支架源性裂口再次接受TEVAR;18例假腔完全血栓化,11例假腔部分血栓化,6例假腔未血栓化;1例新发卒中,1例新发截瘫。结论ATBAD患者行急诊TEVAR的近远期疗效确切,安全可靠,可以有效挽救患者生命。Objective To analyze the near and far-term effects of emergency thoracic endovascular aortic repair(TEVAR)in patients with actue type B aortic dissection(ATBAD).Methods The clinical data of 72 patients diagnosed with ATBAD who were admitted to General Hospital of Northern Theater Command from January 2010 to December 2022 and whose time from admission to TEVAR was less than 24 hours were retrospectively analyzed,including baseline data,operation status and postoperative follow-up.Results None of the 46 patients died during operation,and the success rate of immediate operation was 100.0%(46/46).Intraoperative typeⅠinternal leakage occurred in 1 case.Three patients died in hospital after operation,two died because of aortic rupture and one died because of multiple organ failure.At the follow-up from discharge to 30 days after surgery,no patient died or had an aorta-related adverse event.The mean long-term follow-up was(36.6±26.1)months.Of the two patients who died,one died of aortic rupture at 66 days after discharge,and the other died of heart failure at 12 months after discharge.Aorta-related adverse events occurred in 6 patients,including 1 major artery-derived death,1 retrograde type A aortic dissection,3 new internal leakage,and 1 patient receiving TEVAR again due to stent-derived tear.There were complete thrombus in 18 cases,partial thrombus in 11 cases,and no thrombus in 6 cases.There was one new stroke and one new paraplegia.Conclusion The near and far-term curative effect of TEVAR in emergency treatment of ATBAD patients is accurate,safe and reliable,and can effectively save patients′lives.

关 键 词：急性B型主动脉夹层 急诊胸主动脉腔内修复术 疗效分析 

分 类 号：R543.1[医药卫生—心血管疾病]