急性主动脉夹层的治疗(附13例报道)

Selection of treating methods for acute aortic dissection

目的 :探讨急性主动脉夹层急诊治疗方法的选择。方法 :对作者在阜外心血管病医院外科急诊 1个月所见 13例病人的临床资料进行分析。结果 :本组药物治疗 2例 ,手术治疗 6例 ,主动脉内支架置入治疗 2例 ,均痊愈出院 ;1例因合并腹腔脏器缺血坏死放弃治疗 ;2例在急诊药物治疗过程中主动脉夹层破裂猝死。结论 :急诊药物治疗是所有急性主动脉夹层病人的基本治疗。急性主动脉夹层急诊外科治疗方法的选择主要根据主动脉夹层Debakey分型。DebakeyⅠ型、Ⅱ型应尽早手术 ;DebakeyⅢ型积极的药物治疗与外科手术效果相似 ,选择急诊手术治疗有一定的指征 ;DebakeyⅢ也可行主动脉内支架置入治疗。

Objective:To explore the selection of the treatment methods for acute aortic dissection.Methods:Thirteen patients with acute aortic dissection were studied and analyzed.Results:Of the 13 patients,2 received pharmacotherapy;6 underwent surgical treatment;2 were treated with inplantation of intravascular stent-grafts;1 experienced no treatment because of the ischemic necrosis of the abdominal organs,and 2 suddenly died of the rupture of aortic dissection in the course of emergent management.Conclusion:The emergent pharmacotherapy is essential to all patients with acute aortic dissection.The emergent surgical treatment of acute aortic dissection is selected mainly according to the Debakey Classification.Patients with Debakey Type Ⅰ and Ⅱaortic dissection should undergo operation as early as possible.The outcome of pharmacotherapy is similar to that of surgical treatment based on suitable indications for Debakey Type Ⅲ aortic dissection.Debakey Type Ⅲ aortic dissection can be treated by the intravascular stent-grafts too.