DeBakeyⅢ型主动脉夹层动脉瘤腔内隔绝术的围手术期处理

Peri-operative Management of DeBakey TypeⅢ Aortic Dissecting Aneurysm Treated by Endovascular Exclusion

目的：探讨ＤｅｂａｋｅｙⅢ型主动脉夹层动脉瘤腔内隔绝术的围手术期处理。方法：６５例ＤｅｂａｋｅｙⅢ型主动脉夹层动脉瘤病人接受了腔内隔绝术。术后监测各项生命体征，观察尿量及颜色、两上肢脉搏及血压、上下肢血供及末梢循环、肢体肌力变化、胸背部疼痛及神经反射。结果：移植物置入成功率为９８．４６％，术中输血量平均为９３．５ｍｌ。心电监护平均４８ｈ，其中５２例入ＩＣＵ病房，平均监测１９ｈ。胃管留置平均３ｈ，尿管平均留置１６ｈ。术后发生脑血管意外２例、胸骨后疼痛５例、左上肢乏力３例、血小板降低６４例、术后发热５８例、切口渗血或血肿５例。术后３０天内死亡２例。结论：主动脉夹层动脉瘤腔内隔绝术的围手术期处理有一定特殊性。该术式虽属微创手术，但术后易出现脑血管意外、心源性猝死、分支动脉闭塞及移植物引起的胸痛、大量Ｘ射线引起的腔内隔绝术后综合征等，应掌握处理的特殊性。

Objective: To investigate the peri-operative management of DeBakey typeⅢaortic dissecting aneurysms treated by the endovascular exclusion procedure. Methods: Sixty-five patients with DeBakey typeⅢaortic dissecting aneurysms underwent the endovasular exclusion procedure. The vital signs, urine output, pulse and blood pressure of the limbs, the microcirculation status, strength of the limbs and the nervous reflexes were monitored regularly. Results: The placement of grafts was carried out successfully in 64 cases. The mean volume of blood infused during the operation was 93.5ml. ECG monitoring was needed in an average of 48 hours. Fifty-two patients were monitored in the intensive care unit, with an average duration of stay of 19 hours. The postoperative complications include: cra nial stroke(2 cases), poststernal pain(5 cases), left upper limb adynamia(3 cases), drop in platelet count(64 cases), fever(58 cases) and exudation or hematoma of the wound(5 cases). Two patients died within thirty days after operation. Conclusions: The peri-operative management of DeBakey typeⅢaortic dissecting aneurysms treated with the endovascular exclusion, although a mini-invasive procedure, is frequently accompanied by important postoperative complications as intracranial vascular accident, cardiac sudden death, obstruction of arterial branches, pain induced by the stent graft, and the post-exclusive syndrome induced by an excessive exposure to the X-rays. High alert and meticulous care are thus mandatory during the post-operative period.