摘要
目的 探讨A型主动脉夹层(AD)患者升主动脉置换+全弓置换+象鼻子支架术治疗后早中期凝血/纤溶变化情况.方法 依照纳入、排除标准选取2017年8月至2018年8月间在新疆维吾尔自治区人民医院心外科收治的A型AD患者为研究对象.彩色多普勒超声心动图和电子计算机断层扫描检查确诊为AD患者,按照发病的持续时间分为急性AD组(病程<2周)和慢性AD组(病程≥2周),两组患者均行升主动脉置换+全弓置换+象鼻子支架术治疗.两组患者抽取空腹静脉血,采用酶联免疫吸附法检测凝血指标[凝血酶原时间(PT)、部分活化凝血活酶时间(APTT)、纤维蛋白原(Fib)、骨形态发生蛋白(BMP)]及纤溶指标[D-二聚体(D-dimer)、组织型纤溶酶原激活物活性(t-PA)、组织型纤溶酶原激活物抑制物(PAI)].结果 酶联免疫吸附实验结果显示,急性AD组和慢性AD组患者术后12个月血浆PT、APTT、Fib、BMP、D-dimer以及PAI与术前比较降低(P<0.05),t-PA与术前比较升高(P<0.05).两组术后有效率、住院死亡率、住院时间、住院并发症发生率以及早中期生存率差异无统计学意义(P>0.05).结论 升主动脉置换+全弓置换+象鼻子支架术治疗急、慢性A型AD患者效果均较好,可显著改善术后早中期凝血/纤溶指标的表达.
Objective To investigate the changes of coagulation/fibrinolysis factors in patients with type A aortic dissection(AD)at early and middle stages after ascending aorta replacement+total arch replacement+elephant nose stenting.Methods According to the inclusion and exclusion criteria,patients with type A AD who underwent cardiac surgery in Xinjiang Uygur Autonomous Region People′s Hospital from August 2017 to August 2018 were selected as the study group.According to the duration of onset,patients were divided into acute AD group(course<2 weeks)and chronic AD group(course≥2 weeks).Both groups were treated with ascending aorta replacement+total arch replacement+elephant nose stenting.Fasting venous blood was drawn from the two groups,and the blood indexes[prothrombin time(PT),activated partial thrombo plastin time(APTT),fibrinogen(Fib),bone morphogenetic proteins(BMP)]and fibrinolysis indexes[D-dimer,tissue-type plasminogen activator(t-PA),plasminogen activator inhibitor(PAI)]were detected by enzyme-linked immunosorbent assay(ELISA).Results The ELISA result showed that changes of PT,APTT,Fib,BMP,D-dimer,and PAI in patients with acute and chronic AD at 12 months after operation were significantly lower than those before operation(P<0.05).The changes of t-PA in patients with acute and chronic AD at 12 months after operation were significantly higher than those before operation(P<0.05).There was no significant difference in postoperative effective rate,in-hospital mortality,length of stay,incidence of complications and early and mid-term survival rate between the two groups(P>0.05).Conclusions Ascending aorta replacement+total arch replacement+elephant nose stent is effective in the treatment type A AD,and can significantly improve the expression of coagulation/fibrinolysis markers in early and middle period after operation.
作者
买买提艾力·艾则孜
买买提·依斯热依力
张为民
郭永忠
张总刚
Maimaitiaili Aizezi;Maimaiti Yisireyili;Zhang Weimin;Guo Yongzhong;Zhang Zonggang(Department of Cardiac Surgery,People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China;Research Institute of General and Minimally Invasive Surgery,People′s Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830001,China)
出处
《中国医师杂志》
CAS
2020年第7期1009-1013,共5页
Journal of Chinese Physician
基金
新疆维吾尔自治区人民医院科技引进创新项目(20170111)。
关键词
心血管外科手术
A型主动脉夹层
血液凝固试验
纤维蛋白溶解
Cardiovascular surgical procedures
Type A aortic dissection
Blood coagulation tests
Fibrinolysis
