血液吸附治疗在A型主动脉夹层手术中应用研究

Application of hemadsorption therapy in type A aortic dissection surgery

目的探讨血液吸附治疗在A型主动脉夹层手术中应用的安全性和有效性。方法选取自2022年3月至2022年11月北部战区总医院心血管外科收治的A型主动脉夹层患者60例,随机分为A组(n=30)与B组(n=30)。两组患者均经胸骨上段小切口在中度低温停循环双侧脑灌注结合下半身灌注下行孙氏手术。B组在体外循环开始时,同时实施血液吸附治疗。收集患者入院时一般资料、手术相关指标(主动脉根部手术方式、体外循环时间、主动脉阻断时间、停循环时间、最低鼻咽温)、术后指标(二次插管、引流量、呼吸机辅助时间、ICU停留时间、术后住院时间、术后脑卒中)以及围术期输血、白细胞介素6(IL-6)水平。记录两组患者术后死亡情况。结果B组呼吸机辅助时间、ICU停留时间均明显短于A组,差异有统计学意义(P<0.05)。术前及术后72 h,两组间IL-6水平比较,差异无统计学意义(P>0.05)。术后24 h,B组IL-6水平低于A组,差异有统计学意义(P<0.05)。两组患者术后24 h的IL-6水平均较术前明显升高,术后72 h的IL-6水平均较术后24 h明显降低,差异有统计学意义(P<0.05)。结论血液吸附治疗可安全的用于A型主动脉夹层手术中,术中应用HA380进行吸附治疗可在一定程度上降低术后24 h的IL-6水平,并显著缩短呼吸机辅助时间、ICU停留时间。

Objective To investigate the safety and efficacy of hemadsorption therapy in type A aortic dissection surgery.Methods A total of 60 patients with type A aortic dissection admitted to the Department of Cardiovascular Surgery,General Hospital of Northern Theater Command from March 2022 to November 2022 were randomly divided into group A(n=30)and group B(n=30).Both groups underwent Sun’s procedure with an upper hemisternotomy under moderate hypothermic circulatory arrest with bilateral cerebral perfusion and lower body perfusion.Group B was treated with hemadsorption therapy at the beginning of cardiopulmonary bypass.The general data of the patients on admission,operation related indicators(aortic root operation method,extracorporeal circulation time,aortic cross-clamp time,circulatory arrest time,minimum nasopharyngeal temperature),postoperative indicators(secondary intubation,drainage volume,ventilator support time,ICU staying time,postoperative hospital stay time,postoperative stroke),and perioperative blood transfusion and interleukin-6(IL-6)were collected.The postoperative death of patients in the two groups was recorded.Results The ventilator support time and ICU staying time in group B were significantly shorter than those in group A(P<0.05).There was no significant difference in IL-6 level between the two groups before operation and at 72 hours after operation(P>0.05).The level of IL-6 in group B was lower than that in group A at 24 hours after the operation,and the difference was statistically significant(P<0.05).The IL-6 levels of the two groups at 24 hours after the operation were significantly higher than those before the operation,and the IL-6 levels at 72 hours after the operation were significantly lower than those at 24 hours after the operation,and the differences were statistically significant(P<0.05).Conclusion Hemoadsorption therapy can be safely used in the operation of type A aortic dissection.The application of HA380 during the operation can reduce the level of IL-6 at 24 hours after the operation,and significantly shorten the ventilator support time and ICU staying time.