主动脉根部替换术后出血的临床对策

Clinical Tactics for Inaccessible Bleeding in Aortic Root Replacement

目的总结应用主动脉-右心房分流技术减少主动脉根部替换术后出血的临床效果和分流手术的技术难点与要点。方法回顾我院1989年4月至2005年12月的515例主动脉根部替换术,术中发生根部出血或预防性应用主动脉根部-右房分流112例。总结体外循环时间,术后胸腔引流量,平均输入血液制品量,二次开胸止血比率及出血相关并发症的发生率。结果在112例主动脉根部-右房分流中男性91例,女性21例;平均年龄(40±12．8)岁,体重(51～95)kg,平均(69±10．6) kg。在完成分流后,所有患者主动脉根部均得到充分止血,术后胸腔引流量400～1340 ml,平均(848±271)ml。平均输血(750±250)ml,血浆(370±230)ml。3例因主动脉远端吻合口渗血行二次开胸止血。1例术后3个月因血管移植物感染死亡外,余患者均存活。出院前常规超声心动图检查提示主动脉根部与右心房间无血流流动。超高速CT(UFCT)检查显示主动脉根部有血栓形成。结论主动脉-右心房分流技术操作简单,可以有效减少主动脉根部替换术后出血,显著改善主动脉根部替换手术的临床效果,减少出血相关并发症,缩短手术时间,降低手术费用。

Objective To estimate clinical outcome of aortoatrial shunts for inaccessible bleeding in aortic root replacement. Methods Review 515 cases of aortic root replacement done in our hospital from 4, 1989 to 12, 2005. Among them 112 cases were performed aortoatrial shunts for inaccessible bleeding in aortic root. Estimate the CPB time, postoperative bleeding volume, blood products perfusion volume, morbidity of re-open chest for bleeding. Results Amongthe 112 cases, male 91, female21; average age 40±12. 8 ; average weights 69 ± 10.6 kg; postoperative bleeding volume is 400 ～ 1340 ml, average 848 ± 271 ml. Average blood perfusion volume is 750 ± 250 ml. Average plasma perfusion volume is 370 ± 230 ml. 3 cases were performed re-open chest for bleeding of remote anastomosis site. 1 died for infection of graft. Conclusion Aortoatrial shunts can effectively control inaccessible bleeding in aortic root replacement. It also can reduce CPB time, lessen postoperative bleeding volume and blood products perfusion volume.