急性A型主动脉夹层的急诊手术

Emergency operation of acute type A aortic dissection

目的总结急性A型主动脉夹层(AAAD)的外科治疗经验。方法回顾分析我科收治行急诊手术治疗的19例AAAD临床资料。其中17例行升主动脉置换,2例行Bentall+主动脉弓置换术。前17例中同期行:主动脉瓣置换术5例,主动脉弓置换术+主动脉瓣置换术3例,主动脉弓置换术加"象鼻"手术3例,主动脉瓣成形术1例。Bentall术+主动脉弓置换术+"象鼻"手术1例,主动脉弓置换术+"象鼻"手术+支架置入术1例。全组13例应用了深低温停循环(DHCA)。7例应用了选择性脑灌注(SCP),5例应用了上腔静脉逆行脑灌注(RCP)。结果平均体外循环时间(267±101)min。平均心肌隔断时间(174±69)min。SCP时间(32±16)min,无住院死亡。结论对AAAD应采用积极的急诊手术治疗。正确的手术指征、技巧和脑保护是手术成功的关键。

Objective To explore the surgical experiende for acute type A aortic dissection（AAA ）. Methods Nineteen patients with acute type A aortic disseetion treated Surgically were studied and analyzed. Results Catdiopulmonary bypass time was （ 174 ± 69）min, average cross clamp Lime was （267 ± 101 ） min, and average selective cerebral perfusion and lower body arrest Lime was （32 ± 16） min. There was no death during hospital stay. Conclusion Emergency surgery treatment is a good choice for acute type A aortic dissection. Proper surgical indication, technique and brain protections are the key factors of acute A aortic dissection surgery.