Analysis of the Treatment for Acute Stanford Type A Aortic Dissection in Primary Hospital_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

刘建平 ¹ , 夏娟 ² ,  张永恒 ¹ , 李小强 ³ , 杨波 ¹ , 周海宁 ¹

1. ;
2. ;
3. ;

Corresponding author：

张永恒, Email: 735013350@qq.com

Keywords：

Stanford A型主动脉夹层; 三分支主动脉支撑型覆膜支架; 外科手术

DOI：

10.7507/1007-4848.20150131

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目的探讨急性Stanford A型主动脉夹层的临床特点、基层医院救治策略及围术期常见并发症的处理措施。方法回顾性分析遂宁市中心医院2010年2月至2013年9月16例采用三分支主动脉支撑型覆膜支架重建弓部手术治疗的Stanford A型主动脉夹层患者的临床资料，其中男12例、女4例，马凡综合征1例，原发性高血压病15例。分析其临床特点、影像学表现及治疗效果。结果 16例患者手术均成功。本组体外循环时间（202.2±50.4）min，升主动脉阻断时间（94.6±16.9）min，深低温停循环时间（11.5±7.4）min，选择性脑灌注时间（40.6±6.8）min，术后胸腔及心包积液引流量（700.6±368.6）ml，重症监护室停留时间3～26 d。住院期间死亡1例，于术后28 d突发远端夹层破裂死亡。术后发生慢性心脏压塞导致胸骨哆开1例，10例出现一过性精神障碍，5例并发急性肾功能不全，4例出现急性呼吸功能不全，3例出现急性肝功能不全。术后随访15例，门诊及电话随访6～49个月；2例于术后1年随访中因其他慢性疾病死亡；其余13例均存活。结论基层医院采用三分支主动脉支撑型覆膜支架重建弓部手术治疗急性Stanford A型主动脉夹层，简化了手术方式，针对围术期并发症采取有效的治疗措施可显著提高患者生存率。

Citation： 刘建平, 夏娟, 张永恒, 李小强, 杨波, 周海宁. Analysis of the Treatment for Acute Stanford Type A Aortic Dissection in Primary Hospital. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(5): 506-509. doi: 10.7507/1007-4848.20150131 Copy

1.	Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2010, 90(4):1246-1250.
2.	Braverman AC. Aortic dissection:prompt diagnosis and emergency treatment are critical. Cleve Clin J Med, 2011, 78(10):685-696.
3.	刘建平, 夏娟, 敬毅, 等.基层医院急性主动脉夹层救治策略.中国医药导报, 2014, 11(12):32-35.
4.	王克学, 杨再珍, 王正飞, 等.三分支主动脉弓覆膜支架用于DeBakey I型主动脉夹层99例分析.重庆医学, 2012, 41(19):1987-1988.
5.	孙立忠, 刘志刚, 常谦, 等.主动脉弓替换加支架"象鼻"手术治疗Stanford A型主动脉夹层.中华外科杂志, 2004, 42(13):812-816.
6.	董逸飞, 卢安东, 闵凯, 等. Stanford A型主动脉夹层的外科治疗.中国胸心血管外科临床杂志, 2013, 20(6):647-652.
7.	Ma WG, Zhu JM, Zheng J, et al. Sun's procedure for complex aortic arch repair:total arch replacement using a tetrafurcate graf with stented elephant trunk implantation. Ann Cardiothorac Surg, 2013, 2(5):642-648.
8.	Chen LW, Dai XF, Lu L, et al. Extensive primary repair of the thoracic aorta in acute type A aortic dissection by means of ascending aorta replacement combined with open placement of triplebranched stent graf:early results. Circulation, 2010, 122(14):1373-1378.
9.	Chen LW, Wu XJ, Li QZ, et al. A modifed valve-sparing aortic root replacement technique for acute type A aortic dissection:the patch neointima technique. Eur J Cardiothorac Surg, 2012, 42(4):731-733.
10.	崔勇丽, 王子珩, 孙晓刚, 等.急性主动脉夹层的凝血功能特点及围术期变化.中国现代普通外科进展, 2013, 16(6):476-479.
11.	Sørensen B, Tang M, Larsen OH, et al. Te role of fbrinogen:a new paradigm in the treatment of coagulopathic bleeding. Tromb Res, 2011, 128(1):S13-S16.
12.	Nomura F, Tamura K, Yoshitatsu M, et al. Changes in coagulation condition, cytokine, adhesion molecule afer repair of type A aortic dissection. Eur J Cardiothorac Surg, 2004, 26(2):348-350.
13.	秦卫, 黄福华, 陈鑫, 等.深低温停循环联合顺行性脑灌注对患者认知功能的影响.中国胸心血管外科临床杂志, 2014, 21(1):71-74.
14.	Haldenwang PL, Wahlers T, Himmels A, et al. Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients. Eur J Cardiothorac Surg, 2012, 42(5):e115-e120.
15.	舒畅, 张文波.主动脉夹层的降压药物治疗.中国实用外科杂志, 2011, 31(12):1098-1099.
16.	Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury afer thoracic aortic surgery for acute dissection. Ann Torac Surg, 2012, 94(3):766-771.
17.	杨勇, 李小密, 李菲, 等.主动脉弓置换术后急性肾损伤发生的危险因素分析.中国胸心血管外科临床杂志, 2011, 18(2):109-113.
18.	喻磊, 谷天祥, 师恩袆, 等.深低温停循环肾损伤及其早期检测.中国胸心血管外科临床杂志, 2014, 21(1):90-96.
19.	Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction afer surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3):691-696.
20.	李玉叶, 高占成.肺内外源性急性呼吸窘迫综合征与细胞因子相关性的研究进展.中国临床医生, 2014, 42(2):10-13.
21.	del Porto F, Proietta M, Tritapepe L. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8):622-629.
22.	孙博, 刘楠, 邢晓燕, 等.急性Stanford A型主动脉夹层围术期急性肺损伤与D-二聚体相关性的探讨.心肺血管病杂志, 2013, 32(1):26-29.
23.	李茂琴, 李家琼, 许继元, 等.反复肺复张联合肺保护性通气对急性呼吸窘迫综合征患者肺损伤的作用.中华临床医师杂志(电子版), 2011, 5(15):4377-4380.
24.	Achouh PE, Madsen K, Miller CC, et al. Gastrointestinal complications afer descending thoracic and thoracoabdominal aortic repairs:a 14-year experience. J Vasc Surg, 2006, 44(3):442-446.

1. Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2010, 90(4):1246-1250.
2. Braverman AC. Aortic dissection:prompt diagnosis and emergency treatment are critical. Cleve Clin J Med, 2011, 78(10):685-696.
3. 刘建平, 夏娟, 敬毅, 等.基层医院急性主动脉夹层救治策略.中国医药导报, 2014, 11(12):32-35.
4. 王克学, 杨再珍, 王正飞, 等.三分支主动脉弓覆膜支架用于DeBakey I型主动脉夹层99例分析.重庆医学, 2012, 41(19):1987-1988.
5. 孙立忠, 刘志刚, 常谦, 等.主动脉弓替换加支架"象鼻"手术治疗Stanford A型主动脉夹层.中华外科杂志, 2004, 42(13):812-816.
6. 董逸飞, 卢安东, 闵凯, 等. Stanford A型主动脉夹层的外科治疗.中国胸心血管外科临床杂志, 2013, 20(6):647-652.
7. Ma WG, Zhu JM, Zheng J, et al. Sun's procedure for complex aortic arch repair:total arch replacement using a tetrafurcate graf with stented elephant trunk implantation. Ann Cardiothorac Surg, 2013, 2(5):642-648.
8. Chen LW, Dai XF, Lu L, et al. Extensive primary repair of the thoracic aorta in acute type A aortic dissection by means of ascending aorta replacement combined with open placement of triplebranched stent graf:early results. Circulation, 2010, 122(14):1373-1378.
9. Chen LW, Wu XJ, Li QZ, et al. A modifed valve-sparing aortic root replacement technique for acute type A aortic dissection:the patch neointima technique. Eur J Cardiothorac Surg, 2012, 42(4):731-733.
10. 崔勇丽, 王子珩, 孙晓刚, 等.急性主动脉夹层的凝血功能特点及围术期变化.中国现代普通外科进展, 2013, 16(6):476-479.
11. Sørensen B, Tang M, Larsen OH, et al. Te role of fbrinogen:a new paradigm in the treatment of coagulopathic bleeding. Tromb Res, 2011, 128(1):S13-S16.
12. Nomura F, Tamura K, Yoshitatsu M, et al. Changes in coagulation condition, cytokine, adhesion molecule afer repair of type A aortic dissection. Eur J Cardiothorac Surg, 2004, 26(2):348-350.
13. 秦卫, 黄福华, 陈鑫, 等.深低温停循环联合顺行性脑灌注对患者认知功能的影响.中国胸心血管外科临床杂志, 2014, 21(1):71-74.
14. Haldenwang PL, Wahlers T, Himmels A, et al. Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients. Eur J Cardiothorac Surg, 2012, 42(5):e115-e120.
15. 舒畅, 张文波.主动脉夹层的降压药物治疗.中国实用外科杂志, 2011, 31(12):1098-1099.
16. Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury afer thoracic aortic surgery for acute dissection. Ann Torac Surg, 2012, 94(3):766-771.
17. 杨勇, 李小密, 李菲, 等.主动脉弓置换术后急性肾损伤发生的危险因素分析.中国胸心血管外科临床杂志, 2011, 18(2):109-113.
18. 喻磊, 谷天祥, 师恩袆, 等.深低温停循环肾损伤及其早期检测.中国胸心血管外科临床杂志, 2014, 21(1):90-96.
19. Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction afer surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3):691-696.
20. 李玉叶, 高占成.肺内外源性急性呼吸窘迫综合征与细胞因子相关性的研究进展.中国临床医生, 2014, 42(2):10-13.
21. del Porto F, Proietta M, Tritapepe L. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8):622-629.
22. 孙博, 刘楠, 邢晓燕, 等.急性Stanford A型主动脉夹层围术期急性肺损伤与D-二聚体相关性的探讨.心肺血管病杂志, 2013, 32(1):26-29.
23. 李茂琴, 李家琼, 许继元, 等.反复肺复张联合肺保护性通气对急性呼吸窘迫综合征患者肺损伤的作用.中华临床医师杂志(电子版), 2011, 5(15):4377-4380.
24. Achouh PE, Madsen K, Miller CC, et al. Gastrointestinal complications afer descending thoracic and thoracoabdominal aortic repairs:a 14-year experience. J Vasc Surg, 2006, 44(3):442-446.

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