合并脑灌注不足的急性Stanford A型主动脉夹层的外科治疗

Surgical management of acute type A aortic dissection with cerebral malperfusion

目的总结急性Stanford A型主动脉夹层合并脑灌注不足患者的外科治疗方法及结果。方法回顾南京市第一医院2010年1月至2019年6月期间手术治疗的589例急性Stanford A型主动脉夹层患者,筛选出术前新发神经系统功能障碍患者,临床表现为:偏瘫和/或下肢轻瘫,结合术前主动脉CTA排除单纯由于下肢低灌注引起的下肢功能障碍患者。16例符合上述条件,男13例,女3例,年龄26~72岁,平均(53.9±11.2)岁,左侧偏瘫8例,左下肢轻瘫5例,右下肢轻瘫3例,均为急性发病。回顾性分析16例患者临床资料、手术方式及预后。结果15例行孙氏手术,1例行单纯行主动脉替换手术;同期行主动脉瓣置换术2例,冠状动脉旁路移植术2例,转流术2例,1例术后因下肢坏死行截肢术。全组7例住院期间死亡,主要死因均为大面积脑梗塞。结论术前脑灌注不足是急性A型主动脉夹层患者的高危因素,积极的手术治疗对挽救此类患者至关重要,具体手术方式需根据患者具体病情决定。

Objective To summarize the surgical treatment and it’s results of patients with acute type A aortic dissection with cerebral malperfusion.Methods We collected and analyzed the clinical date of 16 patients,who were hospitalized and underwent operation Between January 2010 to June 2019,presented cerebral malperfusion due to acute type A aortic dissection.All of them showed preoperative newly developed neurologic deficits,left hemiplegia in 8 cases,left paraparesis in 5 cases and right paraparesis in 3 cases.Results Aortic valve was involved in 5 patients,2 of whom underwent AVR surgery,2 cases of CABG and 2 cases of artificial graft bypass were performed at the same time,1 case underwent left leg amputation postoperatively.Seven patients died after surgery.Conclusion The results of surgical management of acute type A aortic dissection with cerebral malperfusion demonstrated high hospital mortality,which needs us to restore the cerebral perfusion as soon as possible.The specific method should be decided according to the patients'condition.