血管内修复术后植入后综合征的临床研究

Clinical study of post-implantation syndrome after endovascular repair

动脉瘤是继动脉粥样硬化的第二大主动脉疾病,血管内胸主动脉腔内修复术(TEVAR)是治疗其的一线方法。相对于传统开放性手术而言,腔内修复术的最大优势在于侵入性较小,可以缩短术后恢复时间,降低早期死亡率。随着技术的成熟及普及,临床医生逐渐重视术后并发症的发生。相较于动脉瘤而言,Stanford B型主动脉夹层(TBAD)的血流速度更快、病情更紧急、炎症反应更强、持续时间更长,几乎在所有接受TEVAR后的患者都观察到以C-反应蛋白(CRP)、纤维蛋白原、D-二聚体和白细胞计数(WBC)升高为特征的术后炎症反应持续时间较长。当血管内修复术后早期出现发热,应尽早识别、准确鉴别发热的原因,做出正确的临床干预,及时调整治疗方案,对患者术后康复指导具有重要意义。本文主要对植入后综合征(PIS)的影响因素、临床常用的炎症指标及目前的治疗进展和预后进行综述。

Aneurysm is the second major aortic disease after atherosclerosis, and endovascular thoracic endovascular aortic repair(TEVAR) is the first line of treatment. Compared with traditional open surgery, the biggest advantage of endovascular prosthetics is that it is less invasive, can shorten postoperative recovery time and reduce early mortality. With the maturity and popularization of technology, clinicians gradually pay attention to the occurrence of postoperative complications. Compared with aneurysms, Stanford type B aortic dissection(TBAD) has faster blood flow rate, more urgent condition, stronger inflammatory response and longer duration. Almost all patients receiving TEVAR have been observed to have a longer duration of postoperative inflammatory response characterized by increased C-reactive protein(CRP),fibrinogen, D-dimer and white blood cells(WBC). When fever occurs early after endovascular repair, it is of great significance to identify and accurately identify the cause of fever as soon as possible, make correct clinical intervention,and adjust the treatment plan in time, which is of great significance to the postoperative rehabilitation guidance of patients.This article mainly reviews the influencing factors of post-implantation syndrome(PIS), the commonly used clinical inflammatory indicators, the current treatment progress and prognosis.