Staged procedures for extensive aneurysmal disease of the thoracic aorta are a ssociated with a substantial cumulativemortality(20%) that includes hospitalmor tality for the 2 procedures and death(often from aortic ru...Staged procedures for extensive aneurysmal disease of the thoracic aorta are a ssociated with a substantial cumulativemortality(20%) that includes hospitalmor tality for the 2 procedures and death(often from aortic rupture) in the interval between the 2 procedures. We have used a single-stage technique for operative repair of most or all of the thoracic aorta. Forty-six patients with extensive disease of the thoracic aorta were managed with a single-stage procedure by usi ng a bilateral anterior thoracotomy and transverse sternotomy, hypothermic circu latory arrest, and reperfusion of the aortic arch vessels first to minimize brai n ischemia. Thirty-one patients with chronic, expanding type A aortic dissectio ns had previous operations for acute type A dissection(n=22), aortic valve repai r or replacement (n=4), coronary artery bypass grafting(n=4), or no previous ope ration(n=1). The remaining 15 patients had degenerative aneurysms(n=12) or chron ic type B dissections with proximal extension(n=3). The ascending aorta and aort ic arch were replaced in all patients combined with resection of various lengths of descending aorta(proximal one third[n=19], proximal two thirds to three quar ters [n=22], or all [n=5]). Coronary artery bypass grafting, valve replacement, or both were performed concomitantly in 19 patients. Hospital mortality was 6.5 %(3 patients). Morbidity included reoperation for bleeding(17%), mechanical ve ntilation for more than 72 hours(42%), temporary tracheostomy(13%), and tempor ary renal dialysis (9%). No patient sustained a stroke. There have been 5 late deaths(3, 18, 34, 51, and 79 months postoperatively) unrelated to the aortic dis ease. Four patients have undergone successful reoperation on the aorta(false ane urysm[n=1], endocarditis[n=1], and progression of disease [n=2]). Five-year sur vivalwas 75%. The single-stage, arch-first technique is a safe and suitable a lternative to the 2-stage procedure for repair of extensive thoracic aortic dis ease.展开更多
目的观察同期双侧开胸手术中单肺两种通气模式应用时,病人的氧合、血流动力学变化,探讨其效果和肺保护作用。方法 96例病人分为两类,第一类53例单肺通气后采用VCV模式通气,第二类43例单肺先采用VCV模式通气,在出现气道峰压持续升高(PPEA...目的观察同期双侧开胸手术中单肺两种通气模式应用时,病人的氧合、血流动力学变化,探讨其效果和肺保护作用。方法 96例病人分为两类,第一类53例单肺通气后采用VCV模式通气,第二类43例单肺先采用VCV模式通气,在出现气道峰压持续升高(PPEAK>40 cm H2O),改用PCV模式通气,观察病人的氧合及血流动力学变化。结果第一类病人VCV模式通气时能保证基本组织氧合;第二类病人PCV模式与VCV模式通气时相比较,气道压明显降低,PH值增大(P<0.01),PaO2增高(P<0.01),PaCO2降低(P<0.05),SpO2升高,PETCO2降低,差异有统计学意义;HR、CVP、MAP略降低(P>0.05),差异无统计学意义。未发生气压伤等机械通气并发症。结论同期双侧开胸微创手术中,灵活运用两种机械通气模式可较好的维持麻醉病人单肺通气时的呼吸循环管理,有效的避免机械通气并发症的发生,实施肺保护。展开更多
文摘Staged procedures for extensive aneurysmal disease of the thoracic aorta are a ssociated with a substantial cumulativemortality(20%) that includes hospitalmor tality for the 2 procedures and death(often from aortic rupture) in the interval between the 2 procedures. We have used a single-stage technique for operative repair of most or all of the thoracic aorta. Forty-six patients with extensive disease of the thoracic aorta were managed with a single-stage procedure by usi ng a bilateral anterior thoracotomy and transverse sternotomy, hypothermic circu latory arrest, and reperfusion of the aortic arch vessels first to minimize brai n ischemia. Thirty-one patients with chronic, expanding type A aortic dissectio ns had previous operations for acute type A dissection(n=22), aortic valve repai r or replacement (n=4), coronary artery bypass grafting(n=4), or no previous ope ration(n=1). The remaining 15 patients had degenerative aneurysms(n=12) or chron ic type B dissections with proximal extension(n=3). The ascending aorta and aort ic arch were replaced in all patients combined with resection of various lengths of descending aorta(proximal one third[n=19], proximal two thirds to three quar ters [n=22], or all [n=5]). Coronary artery bypass grafting, valve replacement, or both were performed concomitantly in 19 patients. Hospital mortality was 6.5 %(3 patients). Morbidity included reoperation for bleeding(17%), mechanical ve ntilation for more than 72 hours(42%), temporary tracheostomy(13%), and tempor ary renal dialysis (9%). No patient sustained a stroke. There have been 5 late deaths(3, 18, 34, 51, and 79 months postoperatively) unrelated to the aortic dis ease. Four patients have undergone successful reoperation on the aorta(false ane urysm[n=1], endocarditis[n=1], and progression of disease [n=2]). Five-year sur vivalwas 75%. The single-stage, arch-first technique is a safe and suitable a lternative to the 2-stage procedure for repair of extensive thoracic aortic dis ease.
文摘目的观察同期双侧开胸手术中单肺两种通气模式应用时,病人的氧合、血流动力学变化,探讨其效果和肺保护作用。方法 96例病人分为两类,第一类53例单肺通气后采用VCV模式通气,第二类43例单肺先采用VCV模式通气,在出现气道峰压持续升高(PPEAK>40 cm H2O),改用PCV模式通气,观察病人的氧合及血流动力学变化。结果第一类病人VCV模式通气时能保证基本组织氧合;第二类病人PCV模式与VCV模式通气时相比较,气道压明显降低,PH值增大(P<0.01),PaO2增高(P<0.01),PaCO2降低(P<0.05),SpO2升高,PETCO2降低,差异有统计学意义;HR、CVP、MAP略降低(P>0.05),差异无统计学意义。未发生气压伤等机械通气并发症。结论同期双侧开胸微创手术中,灵活运用两种机械通气模式可较好的维持麻醉病人单肺通气时的呼吸循环管理,有效的避免机械通气并发症的发生,实施肺保护。
