多层裸支架技术治疗主动脉夹层动脉瘤患者的术中配合及干预研究  

Intraoperative cooperation and interventional experience of multi-layer bare stent technology in treatment of patients with aortic dissecting aneurism

作　　者：刘娟[1] 钱蓉[1] 罗歆池 周召敏 Liu Juan;Qian Rong;Luo Xinchi;Zhou Zhaomin(Operating Room,Third People's Hospital of Chengdu City,Chengdu 610000,China;不详)

机构地区：[1]成都市第三人民医院手术室,成都610000 [2]德阳市人民医院麻醉手术中心,德阳618000 [3]成都市龙泉驿区第一人民医院胸外科,成都610100

出　　处：《中国循证心血管医学杂志》2025年第1期99-103,共5页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：成都市龙泉驿区卫健系统科研课题(WJKY2023005);西南医科大学建设2022年高等教育教学研究与改革项目(JG2022223)。

摘　　要：目的探讨主动脉夹层动脉瘤(ADA)多层裸支架技术对患者术后血压[舒张压(DBP)、收缩压(SBP)]及安全性的影响,探讨相关干预措施。方法选取成都市第三人民医院于2020年1月至2023年1月收治的经多层裸支架技术治疗的27例ADA患者作为研究对象,利用SPSS 23.0软件对其手术治疗前、后的DBP、SBP表达水平,夹层真、假腔直径,分支动脉通畅率,夹层假腔内血栓化比率(STR)等参数进行统计与分析,综合评估ADA患者术后近、中期疗效及手术治疗的安全性。结果术后随访3个月时27例ADA患者的24 h收缩压(24h SBP)、24 h舒张压(24h DBP)、24 h平均脉压(24h PP)、白昼收缩压(dSBP)、白昼舒张压(dDBP)、夜间收缩压(nSBP)、夜间舒张压(nDBP)等血压指标表达均较手术前更低,计算白昼脉压(dPP)、夜间脉压(nPP)表达水平较手术前更高(P<0.05)。27例ADA患者术后夹层内部分血栓形成从3、6、12、18个月逐渐降低,术后夹层内完全血栓形成从3、6、12、18个月逐渐升高,相同时间节点下两两比较,有统计学差异(P<0.05)。术后3、6、12、18个月时胸主动脉直径较术前均明显降低,腹主动脉直径、真腔最大直径较术前均明显上升(P<0.05)。术后再次开胸探查止血、一过性意识障碍、血液滤过等术后并发症比例分别占总人数的7.41%、3.70%、7.41%,术后并发症总发生率为18.52%。结论多层裸支架技术在ADA的临床治疗中有较高的安全性,近、中期疗效肯定,对主动脉夹层的稳定和支动脉通畅提升均有益,围术期应用主动脉疾病精准护理模式对降低ADA患者血压高表达,稳定血压同样有益。Objective To discuss the influence of multi-layer bare stent technology on blood pressure[diastolic blood pressure(DBP)and systolic blood pressure(SBP)]and safety in patients with aortic dissecting aneurism(ADA),and to investigate relative intervention therapies.Methods ADA patients(n=27)undergone treatment of multi-layer bare stent technology were chosen from the Third People's Hospital of Chengdu City from Jan.2020 to Jan.2023.The levels of DBP,SBP,diameters of true and false lumens,patency rate of branch artery and thrombosis ratio(STR)in false lumen of dissection were statistically analyzed by using SPSS 23.0 software before and after treatment.The short-term and mid-term curative effects and operative safety were comprehensively reviewed in ADA patients.Results After the operation and followed up for 3 months,the levels of 24h SBP,24h PP,24h DBP,dSBP,dDBP,nSBP and nDBP were lower,and levels of dPP and nPP were higher compared with before operation(P<0.05)in 27 ADA patients.After the operation,partial thrombosis in dissection decreased gradually from 3,6,12 to 18 months,and complete thrombosis in dissection increased gradually from 3,6,12 to 18 months,and pair-wise comparison at the same time point showed significant difference(P<0.05).After the operation,diameter of thoracic aorta decreased significantly,and diameter of abdominal aorta and the maximum diameter of true lumen increased significantly at 3,6,12 and 18 months(P<0.05).The observation on postoperative complications showed that percentage of re-thoracotomy for hemostasis was 7.41%,that of transient disturbance of consciousness was 3.70%and that of hemofiltration was 7.41%.The total incidence of postoperative complications was 18.52%.Conclusion The safety,short-term and mid-term curative effects of multi-layer bare stent technology are higher in ADA treatment,which is beneficial to aortic dissection stability and branch arteries patency.The perioperative application of precise nursing mode for aortic diseases is also beneficial to reducing high expre

关 键 词：主动脉夹层动脉瘤 多层裸支架技术 舒张压、收缩压 安全性 

分 类 号：R543.1[医药卫生—心血管疾病]