内脏灌注对马方综合症合并胸腹主动脉置换的转流经验

The management of visceral perfusion to Marfan syndrome with thoracoabdominal aortic aneurysm repair

目的:回顾分析马方综合征(MFS)接受内脏灌注的胸腹主动脉置换(TAAAR)手术患者,评估腹腔脏器保护的效果。方法:2016年9月至2020年8月,共有21例MFS接受TAAAR,其中9例接受内脏灌注。内脏灌注方式为温血灌注腹腔干和肠系膜上动脉;肾脏灌注冷HTK保护液。研究终点为患者死亡、延迟拔管、脑卒中、上下消化道出血、术后CRRT、截瘫或瘫痪。结果:灌注组在体外循环时间[(136.6±23.8)vs.(140.8±80.5)min]、体温[最低肛温(34.2±0.8)vs.(31.2±6.4)℃]、手术时间[(8.7±1.6)vs.(9.2±2.6)]h,均优于非灌注组。灌注组无死亡病例,未灌注组有1例院内术后死亡,死亡比例4.8%。非灌注组1例(8.3%)截瘫,灌注组没有截瘫。术后肾功能不全3例患者,其中灌注组1例(11.1%),非灌注组2例(16.7%)。TAAAR后两组均未见卒中、拔管时间延长、消化道出血。结论:MFS接受TAAAR的患者进行选择性内脏灌注与传统的手术相比安全有效,并且在死亡率、截瘫率、术后CRRT使用率等严重并发症方向有减少的趋势。

Objective:To retrospectively analyze patients with Marfan syndrome(MFS)who underwent thoracoabdominal aortic aneurysm replacement(TAAAR)with visceral perfusion(VP),and to evaluate and summarize the effects of abdominal organ protection.Methods:From September 2016 to August 2020,a total of 21MFS patients underwent TAAAR,of which 9 was performed with VP.The VP was warm blood perfusion in the celiac and superior mesenteric artery;kidney perfusion with cold HTK protective solution.The study endpoints were death,prolonged intubation,stroke,upper and lower gastrointestinal bleeding,postoperative Continuous Renal Replacement Therapy(CRRT),and paraplegia or paralysis.Results:Compared with the non-VP group,the VP group had shorter average cardiopulmonary bypass(CPB)time[(136.6±23.8)vs.(140.8±80.5)min],higher body temperature[lowest rectal temperature(34.2±0.8)vs.(31.2±6.4)℃],and shorter operation time[(8.7±1.6)vs.(9.2±2.6)h]than the non-VP group,though the differences were not statistically significant.There was no death in the VP group,but one postoperative in-hospital death in the non-VP group,with the overall mortality rate being 4.8%.One patient(8.3%)in the non-VP group was paraplegic,and there was no paraplegia in the VP group.There were three patients with postoperative renal insufficiency,including one patient(11.1%)in the VP group and two patients(16.7%)in the non-VP group.There was no stroke,prolonged intubation time,or gastrointestinal bleeding in either group after TAAAR.Conclusions:Though the differences were not statistically significant,selective visceral perfusion in MFS patients undergoing TAAAR can show the tendency of reducing serious complications such as mortality,paraplegia,and postoperative CRRT usage.