DeBakey Ⅰ型主动脉夹层无深低温停循环手术方法的临床研究

Clinical study of DeBakey type Ⅰ aortic dissection without deep hypothermic circulatory arrest

目的探讨无深低温停循环(DHCA)手术的老年De BakeyⅠ型主动脉夹层病人的临床转归及不良反应。方法以2013～2016年在我院就诊的50例老年De BakeyⅠ型主动脉夹层病人为研究对象,其中20例纳入观察组(无DHCA),30例纳入对照组(DHCA)。比较2组病人术中手术情况以及肝功能(天冬氨酸氨基转移酶、丙氨酸氨基转移酶)、肾功能(血清尿素氮、血清肌酐)、凝血功能[血浆凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)]的变化,同时记录2组病人在ICU的情况以及死亡率。结果观察组术中出血量为(1014. 5±113. 7) m L,少于对照组(1526. 6±153. 7) m L;手术后观察组肝肾功能指标均优于对照组,差异有统计学意义(P<0. 05);观察组手术前后凝血功能差异无统计学意义,对照组TT、PT、APTT均高于手术前,FIB低于手术前,差异有统计学意义。此外,观察组术后引流量、苏醒时间、机械通气时间以及ICU滞留时间均低于对照组,差异有统计学意义(P<0. 05); 2组病人术后死亡率差异无统计学意义(P>0. 05)。结论针对老年De BakeyⅠ型主动脉夹层病人,无DHCA对病人肝肾功能及凝血功能影响小,有利于病人术后恢复,具有一定的临床推广价值。

Objective To investigate the effects of non-deep hypothermic circulation arrest( DHCA) on clinical outcome and adverse reactions in the elderly patients with De Bakey typeⅠaortic dissection. Methods Fifty elderly patients with DeBakey typeⅠaortic dissection treated in our hospital from 2013 to 2016 were collected in this study. Twenty cases were enrolled in the observation group( nonDHCA) and 30 cases were enrolled in the control group( DHCA). The operative conditions,indexes of liver function( aspartate aminotransferase, alanine aminotransferase), renal function( serum urea nitrogen and serum creatinine),coagulation function[thromboplastin time( TT),prothrombin time( PT),APTT and fibrinogen( FIB) ]and the related indexes in the ICU and mortality in both groups were recorded. Results The blood loss in the observation group( 1014. 5±113. 7 m L) was less than that in the control group( 1526. 6±153. 7 m L). In the observation group,the changes of liver and renal function indexes were better than those in the control group,and the differences of postoperative coagulation indexes between the two groups were statistically significant( P< 0. 05). In addition,the volume of postoperative drainage,recovery time,mechanical ventilation time and retention of ICU in the observation group were significantly less than those in the control group( P< 0. 05). There was no significant difference in the postoperative mortality between the two groups( P> 0. 05). Conclusions For the elderly patients with DeBakey type Ⅰ aortic dissection,non-DHCA has little effect on liver and renal function and coagulation function,which is conductive to postoperative recovery and has certain clinical value.