A型主动脉夹层伴灌注不良手术效果分析

Operative effect for type A aortic dissection with malperfusion

目的:观察A型主动脉夹层(AAD)伴灌注不良(MPS)手术效果。方法:回顾分析接受手术治疗的160例AAD患者,其中45例合并MPS(MPS组),115例不伴有MPS(NMPS组)。MPS组中21例于AAD发生12h内手术(早期组),24例于AAD发生12h后手术治疗(延迟组)。观察各组MPS处理效果、术中情况及术后恢复情况。结果:早期组和延迟组患者在气管切开例数方面无明显差异,延迟组肾功能不全血滤治疗、肺部感染、永久性神经功能缺损(PND)和一过性神经功能缺损(TND)例数以及院内死亡发生例数较早期组增多(均P<0.05)。MPS和NMPS组患者在选择性顺行脑灌注(ACP)时间、双侧选择性顺行脑灌注(BACP)和单侧选择性顺行脑灌注(UACP)方式选择、术中探查弓部血管累及和中度以上主动脉瓣关闭不全(AR)例数上无明显差异。与MPS组比较,NMPS组患者手术时间、体外循环时间、心脏停搏时间较短(均P<0.05)。MPS和NMPS组再次开胸止血例数无明显差异。与MPS组比较,NMPS组患者ICU滞留时间较短,长期机械通气、肾功能不全血滤治疗、气管切开、肺部感染、PND和TND以及院内死亡例数较少(均P<0.05)。结论:AAD伴MPS手术操作复杂,术后并发症发生率和病死率高,相对而言,早期手术处理效果更佳。

Objective：To investigate operative effect for type A aortic dissection（AAD）with malperfusion（MPS）.Method：One hundred and sixty patients with AAD were retrospectively analyzed,including 45 cases with MPS（MPS group）,115 cases without MPS（NMPS group）.In the MPS group,21 cases underwent surgical operation within 12 hafter AAD occurred（early group）and 24 cases were operated later than 12h（delayed group）.The operation effect,intraoperative condition and postoperative recovery in each group were observed.Result：There was no statistical difference between early group and delayed group in frequency of tracheotomy.Compared with early group,patients in delayed group had more frequent postoperative renal failure needing ultrafiltration,pulmonary infection,permanent neurologic deficit（PND）and temporary neurologic deficit（TND）and hospital death（all P〈0.05）.There was no statistical difference between MPS group and NMPS group in ACP time and frequency of BACP and UACP,AR and arch vessels involved.Compared with MPS group,patients in NMPS group had shorter operating time,cardiopulmonary bypass time and cardiac arrest time（all P〈0.05）.There was no difference between MPS group and NMPS group in frequency of re-operation for bleeding;Compared with MPS group,patients in NMPS group had shorter ICU time,less frequency of long ventilation,postoperative renal failure needing ultrafiltration,tracheotomy,pulmonary infection,PND and TND and hospital death（all P〈0.05）.Conclusion：Operation for AAD with MPS is complex,and the incidence of postoperative complications and mortality is high.Gennerally speaking,earlier operation produces better effects.