孙氏手术处理急性 A 型主动脉夹层合并灌注不良综合征的近期结果_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

邵峻 , 汪露 , 姚昊 , 侍晔 ,  李庆国

南京医科大学第二附属医院心血管病中心（南京 210011）;

Corresponding author：

李庆国, Email: lqg0235062@163.com

Keywords：

主动脉夹层; 灌注不良综合征; 孙氏手术

DOI：

10.7507/1007-4848.201808046

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目的探讨孙氏手术处理急性 A 型主动脉夹层合并灌注不良综合征的临床效果。方法 2014 年 1 月至 2017 年 12 月期间南京医科大学第二附属医院连续收治 A 型主动脉夹层合并灌注不良综合征患者 30 例，其中男 24 例、女 6 例，平均年龄（52.87±12.76）岁。所有患者在深低温停循环，顺行性选择性脑灌注下或经上腔静脉逆行性脑灌注下行四分支人工血管全主动脉弓置换加支架象鼻人工血管植入术（孙氏手术），近端行 Bentall 手术 18 例，单纯升主动脉置换 10 例。同期行冠状动脉旁路移植术 3 例。结果全组平均体外循环时间（196.4±23.5）min，主动脉阻断时间（93.2±8.4）min，深低温停循环时间（24.8±6.3）min。住院死亡 5 例。术后随访 3～42（24.0±13.0）个月，随访率 100.0%，死亡 2 例。结论 A 型主动脉夹层合并灌注不良综合征明显增加了手术风险，但通过孙氏手术能够获得较满意的结果。

Citation： 邵峻, 汪露, 姚昊, 侍晔, 李庆国. 孙氏手术处理急性 A 型主动脉夹层合并灌注不良综合征的近期结果. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(6): 615-618. doi: 10.7507/1007-4848.201808046 Copy

1.	Grimm JC, Magruder JT, Crawford TC, et al. Differential outcomes of type A dissection with malperfusion according to affected organ system. Ann Cardiothorac Surg, 2016, 5(3): 202-208.
2.	Yang B, Patel HJ, Williams DM, et al. Management of type A dissection with malperfusion. Ann Cardiothorac Surg, 2016, 5(4): 265-274.
3.	Czerny M, Schoenhoff F, Etz C, et al. The impact of pre-operative malperfusion on outcome in acute type A aortic dissection: Results from the GERAADA Registry. J Am Coll Cardiol, 2015, 65(24): 2628-2635.
4.	Yagdi T, Atay Y, Engin C, et al. Impact of organ malperfusion on mortality and morbidity in acute type A aortic dissections. J Card Surg, 2006, 21(4): 363-369.
5.	戎天华, 刘永民, 朱俊明, 等. 急性 A 型主动脉夹层合并下肢缺血的诊疗. 首都医科大学学报, 2015, 36(3): 376-381.
6.	Immer FF, Grobety V, Lauten A, et al. Does malperfusion syndrome affect early and mid-term outcome in patients suffering from acute type A aortic dissection? Interact Cardiovasc Thorac Surg, 2006, 5(2): 187-190.
7.	Charlton-Ouw KM, Sritharan K, Leake SS, et al. Management of limb ischemia in acute proximal aortic dissection. J Vasc Surg, 2013, 57(4): 1023-1029.
8.	Orihashi K. Cerebral malperfusion in acute aortic dissection. Surg Today, 2016, 46(12): 1353-1361.
9.	Morimoto N, Okada K, Okita Y, et al. Lack of neurology improvement after aortic repair for type A aortic dissection complicated by cerebral malperfusion:predictor and association with survival. J Thorac Cardiovasc Surg, 2011, 142: 1540-1544.
10.	Tsukube T, Hayashi T, Kawahira T, et al. Neurological outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma. Circulation, 2011, 124(11 Suppl): S163-S167.
11.	Di Eusanio M, Trimarchi S, Patel HJ, et al. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg, 2013, 145(2): 385-390.
12.	Pacini D, Leone A, Belotti LM, et al. Acute type A aortic dissection: significance of multiorgan malperfusion. Eur J Cardiothorac Surg, 2013, 43(4): 820-826.
13.	Perera NK, Galvin SD, Seevanayagam S, et al. Optimal management of acute type A aortic dissection with mesenteric malperfusion. Interact Cardiovasc Thorac Surg, 2014, 19(2): 290-294.
14.	Geirsson A, Szeto WY, Pochettino A, et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg, 2007, 32(2): 255-262.
15.	Neri E, Toscano T, Papalia U, et al. Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome. J Thorac Cardiovasc Surg, 2001, 121(3): 552-560.
16.	Kawahito K, Adachi H, Murata S, et al. Coronary malperfusion due to type A arotic dissection:mechanism and surgical management. Ann Thorac Surg, 2003, 76(5): 1471-1476.

1. Grimm JC, Magruder JT, Crawford TC, et al. Differential outcomes of type A dissection with malperfusion according to affected organ system. Ann Cardiothorac Surg, 2016, 5(3): 202-208.
2. Yang B, Patel HJ, Williams DM, et al. Management of type A dissection with malperfusion. Ann Cardiothorac Surg, 2016, 5(4): 265-274.
3. Czerny M, Schoenhoff F, Etz C, et al. The impact of pre-operative malperfusion on outcome in acute type A aortic dissection: Results from the GERAADA Registry. J Am Coll Cardiol, 2015, 65(24): 2628-2635.
4. Yagdi T, Atay Y, Engin C, et al. Impact of organ malperfusion on mortality and morbidity in acute type A aortic dissections. J Card Surg, 2006, 21(4): 363-369.
5. 戎天华, 刘永民, 朱俊明, 等. 急性 A 型主动脉夹层合并下肢缺血的诊疗. 首都医科大学学报, 2015, 36(3): 376-381.
6. Immer FF, Grobety V, Lauten A, et al. Does malperfusion syndrome affect early and mid-term outcome in patients suffering from acute type A aortic dissection? Interact Cardiovasc Thorac Surg, 2006, 5(2): 187-190.
7. Charlton-Ouw KM, Sritharan K, Leake SS, et al. Management of limb ischemia in acute proximal aortic dissection. J Vasc Surg, 2013, 57(4): 1023-1029.
8. Orihashi K. Cerebral malperfusion in acute aortic dissection. Surg Today, 2016, 46(12): 1353-1361.
9. Morimoto N, Okada K, Okita Y, et al. Lack of neurology improvement after aortic repair for type A aortic dissection complicated by cerebral malperfusion:predictor and association with survival. J Thorac Cardiovasc Surg, 2011, 142: 1540-1544.
10. Tsukube T, Hayashi T, Kawahira T, et al. Neurological outcomes after immediate aortic repair for acute type A aortic dissection complicated by coma. Circulation, 2011, 124(11 Suppl): S163-S167.
11. Di Eusanio M, Trimarchi S, Patel HJ, et al. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg, 2013, 145(2): 385-390.
12. Pacini D, Leone A, Belotti LM, et al. Acute type A aortic dissection: significance of multiorgan malperfusion. Eur J Cardiothorac Surg, 2013, 43(4): 820-826.
13. Perera NK, Galvin SD, Seevanayagam S, et al. Optimal management of acute type A aortic dissection with mesenteric malperfusion. Interact Cardiovasc Thorac Surg, 2014, 19(2): 290-294.
14. Geirsson A, Szeto WY, Pochettino A, et al. Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg, 2007, 32(2): 255-262.
15. Neri E, Toscano T, Papalia U, et al. Proximal aortic dissection with coronary malperfusion: presentation, management, and outcome. J Thorac Cardiovasc Surg, 2001, 121(3): 552-560.
16. Kawahito K, Adachi H, Murata S, et al. Coronary malperfusion due to type A arotic dissection:mechanism and surgical management. Ann Thorac Surg, 2003, 76(5): 1471-1476.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

孙氏手术处理急性 A 型主动脉夹层合并灌注不良综合征的近期结果

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