急性期Stanford A型主动脉夹层患者23例术后早期死亡原因分析

AN ANALYSIS OF EARLY POSTOPERATIVE DEATH IN 23 PATIENTS WITH STANFORD TYPE A ACUTE AORTIC DISSECTION

目的分析急性期Stanford A型主动脉夹层(简称主动脉夹层)患者术后早期死亡的原因,探讨降低此类患者术后病死率的措施。方法回顾性总结分析我院2016年4月—2018年7月120例急性期Stanford A型主动脉夹层手术患者的临床资料,对其术后病人早期死亡原因进行分析。结果本组患者术中均无死亡,术后早期死亡23例,其中死于多脏器功能障碍综合征6例,低心排出量综合征(LCOS)5例,脑出血4例,消化道出血3例,感染性休克2例,大面积脑梗死2例,缺氧缺血性脑病1例。结论术中尽可能缩短手术及体外循环时间;增加各脏器血液灌注,减少缺氧缺血性损伤;积极、有效地预防和处理术后并发症的发生,是防止主动脉夹层病人术后早期死亡的关键。

Objective To analyze the causes of early postoperative death in patients with Stanford type A acute aortic dissection and to explore measures to reduce the postoperative mortality of these patients. Methods The clinical data of 120 surgically treated patients with Stanford type A acute aortic dissection in our hospital from April 2016 to July 2018 were retrospectively summarized, and the causes of early postoperative death were analyzed. Results In the 120 patients, there were no intraoperative deaths, but there were 23 deaths in the early postoperative period, including 6 cases dying of multiple organ dysfunction syndrome,5 cases dying of low cardiac output syndrome,4 cases dying of cerebral hemorrhage,3 cases dying of gastrointestinal blee- ding, 2 cases dying of septic shock,2 cases dying of large-area cerebral infarction, and 1 case dying of hypoxic-ischemic encephalopathy. Conclusion The time of surgery and extracorporeal circulation should be shortened as much as possible. Increase in organ blood perfusion could reduce hypoxic-ischemic injury. Active and effective prevention and treatment of postoperative complications are the key to reducing early postoperative death of patients with aortic dissection.