应用Delphi法制订国人A型主动脉夹层外科治疗专家共识

Using the Delphi method to establish a Chinese experts＇ consensus of the surgical management for type A aortic dissec- tion

目的应用Delphi法制订国人A型主动脉夹层（type A aortic dissection，TAAD）外科治疗的专家共识。方法检索国内外关于TAAD外科治疗的相关文献，初步拟定包括手术禁忌证、动脉插管位置、停循环目标温度、脑灌注方式、手术方式、远端吻合口吻合方式及合并马方综合征等结缔组织病者的外科治疗共7个方面的调查问卷。2015年10月至2016年4月，在全国选取具有代表性的55位心血管外科专家组成专家组，共组织两轮专家评估。采用Delphi法收集专家反馈意见，对评估结果进行统计分析。结果两轮调查的有效问卷回收率分别为80．0％（44／55）和77．27％（34／44），专家协调系数分别为0．31（P〈0．05）和0．32（P〈0．05），专家权威系数分别为0．87和0．83。两轮调查结束后，专家对TAAD外科治疗的7个方面共16个条目达成共识。结论本研究Delphi法专家评估结果可信、结论可靠，初步制订了TAAD外科治疗专家共识，有利于规范我国TAAD的外科治疗。

Objective To establish a Chinese expert consensus of the surgical management for type A aortic dissection （TAAD） by using the Delphi method. Methods A systematic review of the previously published literature related to manage- ment of TAAD at home and abroad was conducted to formulate a questionnaire of clinical consensus of the surgical treatment for TAAD. This questionnaire including seven aspects of surgical management for TAAD, namely contraindications to operative management, cannulation site, target temperature during circulation arrest, cerebral perfusion strategy, surgical procedure, distal anastomotic technique and surgical management for patients with connective tissue disease such as Marfan syndrome. From October 2015 to April 2016, we performed two rounds Delphi survey in which the current professional opinions from 55 experienced and representative cardiovascular surgeons in China, were gathered and analysed. Results The responses rates of two rounds were 80.0% （44/55） and 77.27 % （34/44）. The scores of authoritative coefficient was 0.87 and 0.83. The coef- ficient of concordance were 0.31 （ P 〈 0.05 ） and 0.32 （ P 〈 0.05 ）. After two rounds of consultation, consensus of the surgical management for TAAD was reached on 16 items of seven aspects. Conclusion This Delphi study established an initial Chi- nese expert consensus concerning the surgical management for TAAD, which drew credible results and reliable conclusions. This study will help to standardize the surgical management of TAAD in China.