急性A型主动脉夹层合并心脏压塞的处理策略

Optimal management strategy in patients with acute type A aortic dissection and pericardial tamponade

目的探讨急性A型主动脉夹层合并心脏压塞的处理策略。方法2017—2019年南京医科大学第二附属医院心血管病中心连续收治197例急性A型主动脉夹层患者,其中26例合并心脏压塞[男20例、女6例,平均年龄(59.27±10.76)岁],分析患者的临床资料。结果全组患者均进行了外科手术。中位体外循环时间174.5 min,心肌阻断时间121.5 min。术后并发症包括肾功能衰竭3例、呼吸功能衰竭2例和意识障碍3例。术后5例患者死亡,死亡率19.2%。21例存活患者均完成随访,随访时间2年,随访期间1例死亡,生存率95.2%,无再次手术干预。结论对于急性A型主动脉夹层合并心脏压塞患者,手术前处理策略非常重要。建立完备的24 h待命的心外科团队和一体化的心外科病房,合理优化诊疗过程,缩短从发病到手术的时间,是提高急性A型主动脉夹层合并心脏压塞救治成功率的关键。

Objective To explore the optimal preoperative management strategy in patients with acute type A aortic dissection and pericardial tamponade.Methods A total of 197 patients with acute type A aortic dissection were admitted to the Cardiovascular Center at the Second Affiliated Hospital of Nanjing Medical University from 2017 to 2019,among whom 26 patients suffered from cardiac tamponade,including 20 males and 6 females with an average age of 59.27±10.76 years.The clinical data of the patients were analyzed.Results All patients underwent surgical repair of the aorta.The median cardiopulmonary bypass time and aortic cross clamping time were 174.5 min and 121.5 min,respectively.Postoperative complications included kidney failure in 3 patients,respiratory failure in 2 patients and disturbance of consciousness in 3 patients.Postoperative death occurred in 5(19.2%)patients.The other 21 patients were successfully followed up for 2 years,during which 1 patient died with a survival rate of 95.2%,and no re-intervention was indicated.Conclusion Adequate preoperative management is crucial in patients with acute type A aortic dissection complicated with cardiac tamponade.A cardiac surgery team with round-the-clock availability,an integrated cardiac surgery ward and a rational algorithm that can shorten the time from disease onset to surgery treatment are the keys to improve survival rate.