浅低温小切口行全主动脉弓置换术疗效研究

Study on the efficacy of total aortic arch replacement by small incision with mild hypothermia

目的探讨浅低温小切口下行全主动脉弓置换术患者的疗效。方法回顾性分析自2014年1月至2022年3月北部战区总医院心血管外科收治的324例急性A型主动脉夹层行全主动脉弓置换术患者临床资料,根据患者术中切口方式分为A组(n=171)与B组(n=153)。A组采用中低温胸骨正中切口手术方式,B组采用浅低温单一胸骨上段小切口手术方式。记录并比较两组患者术中、术后相关指标。结果B组患者体外循环时间、主动脉阻断时间、机械通气时间、ICU停留时间明显短于A组,差异有统计学意义(P<0.05)。A组发生肾衰竭2例、短暂性脑卒中3例、长久性脑卒中1例、多系统衰竭2例,术后进行血液透析治疗6例。B组发生肾衰竭1例、多系统衰竭2例,术后进行血液透析治疗3例。结论浅低温小切口手术方式行全主动脉弓置换术,能缩短体外循环时间、主动脉阻断时间,减少患者ICU停留时间,患者预后快,临床疗效满意。

Objective To investigate the efficacy of total aortic arch replacement in patients undergoing small incision with mild hypothermia.Methods A retrospective analysis was performed on 324 patients with acute type A aortic coarctation undergoing total aortic arch replacement admitted to the Cardiovascular Surgery Department of the General Hospital of Northern Theater Command from January 2014 to March 2022,and patients were divided into group A(n=171)and group B(n=153)according to the intraoperative incisional approach.Group A was operated by a median sternal incision with moderate hypothermia,and group B was operated by a single small incision in the upper sternum with mild hypothermia.Intraoperative and postoperative related indexes were recorded and compared between the two groups.Results The extracorporeal circulation time,aortic cross-clamp time,mechanical ventilation time,and ICU stay time of patients in group B were significantly lower than those of patients in group A,and the differences were statistically significant(P<0.05).In group A,there were 2 cases of renal failure,3 cases of transient stroke,1 case of long-lasting stroke and 2 cases of multisystem failure,and 6 cases were treated with hemodialysis after surgery.In group B,there were 1 case of renal failure and 2 cases of multisystem failure,and 3 cases were treated with hemodialysis after surgery.Conclusion Total aortic arch replacement by a mild hypothermic small incision surgical approach can shorten the extracorporeal circulation time,aortic crossclamp time,and reduce the stay of patients in the ICU,and the patients have a rapid prognosis and satisfactory clinical efficacy.