摘要
目的:探讨外膜内翻窦部成形在急性Stanford A型主动脉夹层手术治疗中的应用价值。方法:回顾性分析中国医学科学院阜外医院深圳医院心外科2019年1月至2020年1月50例外膜内翻窦部成形手术治疗的急性Stanford A型主动脉夹层患者的临床资料。其中男性45例,女性5例;平均年龄(50.4±10.0)岁;合并高血压病48例(96.0%);发病到入院时间平均(0.7±1.3)d,入院到行手术时间平均(2.8±5.4)d,术前血肌酐(104.6±76.8)μmol/L,丙氨酸氨基转移酶(29.9±27.9)U/L,天门冬氨酸氨基转移酶(33.0±43.2)U/L,主动脉窦部直径(40.9±6.1)mm,升主动脉直径(46.1±7.3)mm。结果:体外循环时间平均(187.0±43.9)min;主动脉阻断时间平均(122.0±34.3)min,深低温停循环(选择性脑灌注)时间平均(18.9±4.2)min。术中出血平均(2409.4±1572.1)ml。术中输悬浮红细胞平均(1.3±2.0)U。术后24 h胸液引流平均(355.9±282.7)ml。术后呼吸机辅助通气时间平均(42.7±44.4)h。住院天数平均(25.7±10.6)d。全组患者无院内死亡;二次开胸5例;一过性急性肾功能衰竭3例;一过性截瘫2例;消化道出血、肠梗阻2例;轻度膈肌功能障碍1例。所有患者出院前复查主动脉增强CT,人工血管吻合口血流通畅,均康复出院。结论:外膜内翻窦部成形在Stanford A型主动脉夹层手术治疗中效果明确,合理的选择该手术方式,可取得较满意的疗效。
Objectives:To evaluate the treatment efficacy of acute type A Aortic Dissection(ATAAD)with the adventitial inversion technique.Methods:A total of 50 patients(45 males;mean age[50.4±10.0]years)with ATAAD,who underwent surgery with adventitial inversion technique in the department of cardiac surgery,Fuwai hospital,Chinese academy of medical sciences,Shenzhen hospital,from January 2019 to January 2020,were enrolled in this analysis.48 patients(96.0%)had hypertension.The average time from onset to admission was(0.7±1.3)days.The average time from admission to operation was(2.8±5.4)days,Preoperative creatinine was(104.6±76.8)μmol/L,alanine aminotransferase was(29.9±27.9)U/L,aspertate aminotransferase was(33.0±43.2)U/L,aortic sinus diameter was(40.9±6.1)mm,ascending aorta diameter was(46.1±7.3)mm.Results:Cardiopulmonary bypass time was(187.0±43.9)min,cross-clamp time was(122.0±34.3)min,and deep hypothermic circulatory arrest(selective cerebral perfusion)time was(18.9±4.2)min.Thoracic drainage of the first 24 h after surgery was(355.9±282.7)ml.Postoperative ventilator assisted ventilation time was(42.7±44.4)hours.The hospitalization stay was(25.7±10.6)days.There was no in-hospital death.Secondary thoracotomy was performed in 5 cases.There were 3 cases of transient acute renal failure,transient paraplegia in 2 cases,gastrointestinal bleeding and intestinal obstruction in 2 cases,one patient experienced mild diaphragmatic dysfunction.All patients underwent aorta enhanced CT examination before discharge,and satisfactory blood flow at the anastomosis of artificial blood vessel was observed.Conclusions:The adventitial inversion technique is feasible,effective and safe for the treatment of Stanford type A aortic dissection,which is thus a reasonable choice of the operation method for patients with ATAAD.
作者
蒙茂龙
马琼
李刚
王湘
庄贤勉
卢平方
MENG Maolong;MA Qiong;LI Gang;WANG Xiang;ZHUANG Xianmian;LU Pingfang(Department of Cardiac Surgery,Fuwai Hospital,Chinese Academy of Medical Sciences,Shenzhen Hospital,Shenzhen(518000),Guangdong,China)
出处
《中国循环杂志》
CSCD
北大核心
2021年第6期596-600,共5页
Chinese Circulation Journal
关键词
主动脉疾病
主动脉夹层
出血
止血
根部处理
aortic disease
aortic dissection
bleeding
stop the bleeding
the roots of processing
