B型主动脉夹层合并灌注不良综合征的处理体会  

Experiences in the management of type B aortic dissection with malperfusion syndrome

作　　者：谭永辉 房志兰 余永忠[1] 樊孝文[1] 郑翼德[1] Tan Yonghui;Fang Zhilan;Yu Yongzhong;Fan Xiaowen;Zheng Yide(Depaetment of Vascular Surgery,The first people's Hospital of Chenzhou,Chenzhou 423000,China)

机构地区：[1]湖南省郴州市第一人民医院血管外科,郴州423000

出　　处：《中华血管外科杂志》2025年第1期29-35,共7页Chinese Journal of Vascular Surgery

基　　金：湖南省卫生健康委2023年度科研计划课题(B202302057904);湘南学院2022年度校级科研项目(2022JX183)。

摘　　要：目的探讨B型主动脉夹层(TBAD)合并灌注不良综合征(MPS)的处理策略。方法本研究为回顾性纵向研究。收集2021年1月至2023年12月郴州市第一人民医院血管外科收治的14例TBAD合并MPS患者的临床资料,其中男性12例,女性2例;年龄(34.2±5.7)岁。累及单一器官6例,多个部位同时受累8例,包括累及肠道7例,下肢6例(3例为双下肢),肾脏4例(1例为双肾),脊髓3例。对于TBAD合并非脊髓MPS患者,急诊行胸主动脉腔内修复术(TEVAR)并术后造影:MPS器官血供在TEVAR术后恢复,则予以术后抗凝、对症处理;若MPS器官血供仍不佳,则行支架植入重建血运。对于TBAD合并单纯脊髓MPS患者,适当提高目标收缩压至120~140 mmHg,并给予激素、脱水、脑脊液引流等基本处理;对于合并非单纯脊髓MPS患者,在急诊TEVAR联合相应器官血运重建的基础上行前述处理,改善脊髓功能。观察和评估患者手术及随访情况。结果1例TBAD合并单纯脊髓MPS患者行保守治疗,余13例行急诊TEVAR。7例肠道MPS患者TEVAR后,2例肠系膜上动脉真腔开放良好;4例真腔开放不满意,植入裸支架后血供恢复;1例术中高钾血症致心脏骤停死亡。5例下肢MPS患者TEVAR后,其中3例髂动脉真腔开放,未植入支架;2例血供改善不佳,予植入裸支架,术后患肢功能恢复良好。3例肾脏MPS患者TEVAR后,肾动脉真腔开放均不佳,2例加行裸支架植入,术后予血液滤过治疗,肾功能逐渐恢复;1例行球囊扩张成形,术后恢复良好。3例脊髓MPS患者,1例保守治疗1周后恢复良好,2例同时合并其他器官MPS,行TEVAR后1例恢复正常,另1例术后脊髓缺血症状恢复缓慢,肌力为2级。13例患者获得随访数据,中位随访时间为12(9,24)个月。随访期内,主动脉夹层均无Ⅰa型内漏,肠系膜上动脉支架、肾动脉支架及髂动脉支架均通畅。6例肠道MPS患者饮食正常,无腹痛,排便正常;3例肾脏MPS患者肾功能正常1例,维持肾功能2�ObjectiveTo explore the management strategies for type B aortic dissection(TBAD)combined with malperfusion syndrome(MPS).MethodsThe clinical data of 14 patients with TBAD combined with MPS admitted to the Department of Vascular Surgery of the First People's Hospital of Chenzhou from January 2021 to December 2023 were collected,including 12 males and 2 females,aged(34.2±5.7)years.MPS involving a single organ was observed in 6 cases,while multiple sites/organs were involved in 8 cases,including intestines in 7 cases,lower limbs in 6 cases(bilateral lower limbs in 3 cases),kidneys in 4 cases(bilateral kidneys in 1 case),and spinal cord in 3 cases.In patients with TBAD combined with non-spinal MPS,thoracic aortic endovascular repair(TEVAR)was performed on an emergency basis.Postoperative anticoagulation and other symptomatic treatments were performed if the blood supply to the MPS organ is restored on postoperative imaging,and stenting was performed to reestablish blood flow if the blood supply to the MPS organ was poor.For patients with TBAD combined with isolated spinal MPS,the target systolic blood pressure should be raised to 120-140 mmHg,and basic treatments such as hormones,dehydration,and cerebrospinal fluid drainage should be given;for patients with MPS combined with non-simple spinal MPS,the basic treatments mentioned above should be continued to promote the recovery of spinal cord function based on TEVAR combined with the hemodialysis of the corresponding organs in the emergency department.The patients were observed and evaluated during the operation and follow-up.Results13 cases received emergency TEVAR,while 1 case with isolated spinal cord MPS underwent conservative treatment.Following TEVAR in 7 cases with mesenteric MPS,the true lumen of the superior mesenteric artery was successfully restored in 2 cases;4 cases experienced unsatisfactory true lumen expansion,and their blood supply was subsequently improved through the implantation of bare stents for reconstruction;1 case experienced intraoperative hy

关 键 词：主动脉夹层 灌注不良综合征 器官 支架 

分 类 号：R65[医药卫生—外科学]