左心转流在胸腹主动脉替换手术中的应用研究

Application of left heart bypass in thoracoabdominal aortic replacement

目的探讨左心转流技术在胸腹主动脉替换手术中的有效性与安全性,为左心转流在胸腹主动脉动脉替换手术中的应用积累临床经验。方法回顾性分析北京安贞医院心外科于2015年1月至2019年9月期间在左心转流下行胸腹主动脉替换手术的患者资料,并与我院同期在自体血管转流下行胸腹主动脉替换手术患者的术中、术后资料进行对比。结果左心转流组患者22例,其中Crawford分型Ⅰ型2例(9.1%),Ⅱ型18例(81.8%),Ⅲ型2例(9.1%);手术时间(9.0±1.8)h,ICU时间(26.9±23.4)h。术后急性肾功能衰竭接受连续性肾脏替代治疗(CRRT)患者3例(13.6%),截瘫1例(4.5%);二次插管2例(9.1%),其中1例患者气管切开(4.5%);术后30 d死亡1例(4.5%)。同期自体血管转流组患者24例,其中Crawford分型Ⅰ型4例(16.7%),Ⅱ型9例(37.5%),Ⅲ型6例(25%),Ⅳ型5例(20.8%)。手术时间(8.5±2.4)h,ICU时间(35.2±18.9)h。术后急性肾功能衰竭接受CRRT治疗患者4例(16.7%),截瘫2例(8.3%),二次插管2例(8.3%);术后30 d死亡2例(8.3%)。结论左心转流下行胸腹主动脉替换手术与自体血管转流下行胸腹主动脉替换手术比较,其安全性、有效性更高,值得临床推广应用。

Objective To investigate the effectiveness and safety of left heart bypass(LHB)in thoracoabdominal aortic replacement(TAAR),and accumulate clinical experience of LHB application in thoracoabdominal aortic replacement.Methods The materials were respectively analyzed in patients undergone TAAR with LHB,and were compared with those in patients undergone TAAR with autovascular bypass in Department of Cardiac Surgery of Beijing Anzhen Hospital from Jan.2015 to Sept.2019.Results There were 22 patients in LHB group,including 2 cases(9.1%)of Crawford typeⅠ,18(81.8%)of Crawford typeⅡ,2(9.1%)of Crawford typeⅢ.The operation time was(9.0±1.8)h,and length of ICU stay was(26.9±23.4)h.There were 3 cases(13.6%)received continuous renal replacement therapy(CRRT)due to acute renal failure,1(4.5%)of paraplegia,and 2(9.1%)received secondary tracheal intubation with 1 case(4.5%)of tracheotomy.There was 1(4.5%)died 30 d after the operation.There were 24 cases in autovascular bypass group,including 4 cases(16.7%)of Crawford type I,9(37.5%)of Crawford typeⅡ,6(25%)of Crawford typeⅢand 5(20.8%)of Crawford typeⅣ.The operation time was(8.5±2.4)h,and length of ICU stay was(35.2±18.9)h.There were 4 cases(16.7%)received CRRT due to acute renal failure,2(8.3%)of paraplegia,2(8.3%)received secondary tracheal intubation.There were 2 cases(8.3%)died 30 d after the operation.Conclusion TAAR with LHB has higher safety and effectiveness compared with TAAR with autovascular bypass,which is worth to be popularized and applied in clinical practice.