急性DeBakey Ⅰ型主动脉夹层围术期处理

Perioperative management of acute DeBakey Ⅰ aortic dissection

目的:总结急性DeBakey Ⅰ型主动脉夹层围术期处理经验。方法:对2007-01-2010-01期间急诊急性DeBakey Ⅰ型主动脉夹层的117例手术病例进行回顾性分析,其中男103例,女14例,年龄28～63(46.05±12.27)岁,发病至入院时间为3～94(24.16±8.27)h。入院后积极术前准备,术后给予及时、有效的心、肺、脑、肾等脏器支持,防治多器官功能衰竭。结果:本组死亡率为5.13%(6例),放弃治疗9例;治愈102例中并发低心排综合征27例、严重肺部感染13例、一过性脑功能紊乱7例、肾功能不全3例、迟发性心包/胸腔积液14例,均治愈出院。结论:规范的围术期管理是急性DeBakey Ⅰ型主动脉夹层外科治疗成功的重要保障。

Objective：To summarize the perioperative management of acute DeBakey I aortic dissection.Method：Clinical data of 117 patients with acute DeBakey I aortic dissection from Jan,2007to Jan,2010 were retrospectively reviewed.The patients（103 males and 14 females,aged[46.05±12.27]years old）were admitted 3to 94 hours after outbreak.They were given active preparation after admission.After operation,protective therapies for heart,lung,brain and kidney were given in order to prevent multiple organ deficiency syndrome（MODS）.Result： 6cases of in-hospital death occurred and 9cases gave up therapy after operation.Within the 102 survivals,27 cases of low cardiac output occurred,13 cases of severe pneumonia occurred,7 cases of transient cerebral dysfunction occurred,3 cases of renal dysfunction occurred,and 14 cases of pericardial effusion or pleural effusion occurred.All the cases were cured timely.Conclusion：Comprehensive perioperative management is of significant importance to successful therapy of acute DeBakey I aortic dissection.