Analysis of the Treatment for Acute Stanford Type A Aortic Dissection in Primary Hospital_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

劉建平 ¹ , 夏娟 ² ,  張永恒 ¹ , 李小強 ³ , 楊波 ¹ , 周海寧 ¹

1. ;
2. ;
3. ;

Corresponding?author：

張永恒, Email: 735013350@qq.com

Keywords：

Stanford A型主動脈夾層; 三分支主動脈支撐型覆膜支架; 外科手術

DOI：

10.7507/1007-4848.20150131

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目的探討急性Stanford A型主動脈夾層的臨床特點、基層醫院救治策略及圍術期常見并發癥的處理措施。方法回顧性分析遂寧市中心醫院2010年2月至2013年9月16例采用三分支主動脈支撐型覆膜支架重建弓部手術治療的Stanford A型主動脈夾層患者的臨床資料，其中男12例、女4例，馬凡綜合征1例，原發性高血壓病15例。分析其臨床特點、影像學表現及治療效果。結果 16例患者手術均成功。本組體外循環時間（202.2±50.4）min，升主動脈阻斷時間（94.6±16.9）min，深低溫停循環時間（11.5±7.4）min，選擇性腦灌注時間（40.6±6.8）min，術后胸腔及心包積液引流量（700.6±368.6）ml，重癥監護室停留時間3～26 d。住院期間死亡1例，于術后28 d突發遠端夾層破裂死亡。術后發生慢性心臟壓塞導致胸骨哆開1例，10例出現一過性精神障礙，5例并發急性腎功能不全，4例出現急性呼吸功能不全，3例出現急性肝功能不全。術后隨訪15例，門診及電話隨訪6～49個月；2例于術后1年隨訪中因其他慢性疾病死亡；其余13例均存活。結論基層醫院采用三分支主動脈支撐型覆膜支架重建弓部手術治療急性Stanford A型主動脈夾層，簡化了手術方式，針對圍術期并發癥采取有效的治療措施可顯著提高患者生存率。

Citation： 劉建平, 夏娟, 張永恒, 李小強, 楊波, 周海寧. Analysis of the Treatment for Acute Stanford Type A Aortic Dissection in Primary Hospital. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(5): 506-509. doi: 10.7507/1007-4848.20150131 Copy

1.	Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2010, 90(4):1246-1250.
2.	Braverman AC. Aortic dissection:prompt diagnosis and emergency treatment are critical. Cleve Clin J Med, 2011, 78(10):685-696.
3.	劉建平, 夏娟, 敬毅, 等.基層醫院急性主動脈夾層救治策略.中國醫藥導報, 2014, 11(12):32-35.
4.	王克學, 楊再珍, 王正飛, 等.三分支主動脈弓覆膜支架用于DeBakey I型主動脈夾層99例分析.重慶醫學, 2012, 41(19):1987-1988.
5.	孫立忠, 劉志剛, 常謙, 等.主動脈弓替換加支架"象鼻"手術治療Stanford A型主動脈夾層.中華外科雜志, 2004, 42(13):812-816.
6.	董逸飛, 盧安東, 閔凱, 等. Stanford A型主動脈夾層的外科治療.中國胸心血管外科臨床雜志, 2013, 20(6):647-652.
7.	Ma WG, Zhu JM, Zheng J, et al. Sun's procedure for complex aortic arch repair:total arch replacement using a tetrafurcate graf with stented elephant trunk implantation. Ann Cardiothorac Surg, 2013, 2(5):642-648.
8.	Chen LW, Dai XF, Lu L, et al. Extensive primary repair of the thoracic aorta in acute type A aortic dissection by means of ascending aorta replacement combined with open placement of triplebranched stent graf:early results. Circulation, 2010, 122(14):1373-1378.
9.	Chen LW, Wu XJ, Li QZ, et al. A modifed valve-sparing aortic root replacement technique for acute type A aortic dissection:the patch neointima technique. Eur J Cardiothorac Surg, 2012, 42(4):731-733.
10.	崔勇麗, 王子珩, 孫曉剛, 等.急性主動脈夾層的凝血功能特點及圍術期變化.中國現代普通外科進展, 2013, 16(6):476-479.
11.	S?rensen B, Tang M, Larsen OH, et al. Te role of fbrinogen:a new paradigm in the treatment of coagulopathic bleeding. Tromb Res, 2011, 128(1):S13-S16.
12.	Nomura F, Tamura K, Yoshitatsu M, et al. Changes in coagulation condition, cytokine, adhesion molecule afer repair of type A aortic dissection. Eur J Cardiothorac Surg, 2004, 26(2):348-350.
13.	秦衛, 黃福華, 陳鑫, 等.深低溫停循環聯合順行性腦灌注對患者認知功能的影響.中國胸心血管外科臨床雜志, 2014, 21(1):71-74.
14.	Haldenwang PL, Wahlers T, Himmels A, et al. Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients. Eur J Cardiothorac Surg, 2012, 42(5):e115-e120.
15.	舒暢, 張文波.主動脈夾層的降壓藥物治療.中國實用外科雜志, 2011, 31(12):1098-1099.
16.	Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury afer thoracic aortic surgery for acute dissection. Ann Torac Surg, 2012, 94(3):766-771.
17.	楊勇, 李小密, 李菲, 等.主動脈弓置換術后急性腎損傷發生的危險因素分析.中國胸心血管外科臨床雜志, 2011, 18(2):109-113.
18.	喻磊, 谷天祥, 師恩袆, 等.深低溫停循環腎損傷及其早期檢測.中國胸心血管外科臨床雜志, 2014, 21(1):90-96.
19.	Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction afer surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3):691-696.
20.	李玉葉, 高占成.肺內外源性急性呼吸窘迫綜合征與細胞因子相關性的研究進展.中國臨床醫生, 2014, 42(2):10-13.
21.	del Porto F, Proietta M, Tritapepe L. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8):622-629.
22.	孫博, 劉楠, 邢曉燕, 等.急性Stanford A型主動脈夾層圍術期急性肺損傷與D-二聚體相關性的探討.心肺血管病雜志, 2013, 32(1):26-29.
23.	李茂琴, 李家瓊, 許繼元, 等.反復肺復張聯合肺保護性通氣對急性呼吸窘迫綜合征患者肺損傷的作用.中華臨床醫師雜志(電子版), 2011, 5(15):4377-4380.
24.	Achouh PE, Madsen K, Miller CC, et al. Gastrointestinal complications afer descending thoracic and thoracoabdominal aortic repairs:a 14-year experience. J Vasc Surg, 2006, 44(3):442-446.

1. Goda M, Imoto K, Suzuki S, et al. Risk analysis for hospital mortality in patients with acute type A aortic dissection. Ann Thorac Surg, 2010, 90(4):1246-1250.
2. Braverman AC. Aortic dissection:prompt diagnosis and emergency treatment are critical. Cleve Clin J Med, 2011, 78(10):685-696.
3. 劉建平, 夏娟, 敬毅, 等.基層醫院急性主動脈夾層救治策略.中國醫藥導報, 2014, 11(12):32-35.
4. 王克學, 楊再珍, 王正飛, 等.三分支主動脈弓覆膜支架用于DeBakey I型主動脈夾層99例分析.重慶醫學, 2012, 41(19):1987-1988.
5. 孫立忠, 劉志剛, 常謙, 等.主動脈弓替換加支架"象鼻"手術治療Stanford A型主動脈夾層.中華外科雜志, 2004, 42(13):812-816.
6. 董逸飛, 盧安東, 閔凱, 等. Stanford A型主動脈夾層的外科治療.中國胸心血管外科臨床雜志, 2013, 20(6):647-652.
7. Ma WG, Zhu JM, Zheng J, et al. Sun's procedure for complex aortic arch repair:total arch replacement using a tetrafurcate graf with stented elephant trunk implantation. Ann Cardiothorac Surg, 2013, 2(5):642-648.
8. Chen LW, Dai XF, Lu L, et al. Extensive primary repair of the thoracic aorta in acute type A aortic dissection by means of ascending aorta replacement combined with open placement of triplebranched stent graf:early results. Circulation, 2010, 122(14):1373-1378.
9. Chen LW, Wu XJ, Li QZ, et al. A modifed valve-sparing aortic root replacement technique for acute type A aortic dissection:the patch neointima technique. Eur J Cardiothorac Surg, 2012, 42(4):731-733.
10. 崔勇麗, 王子珩, 孫曉剛, 等.急性主動脈夾層的凝血功能特點及圍術期變化.中國現代普通外科進展, 2013, 16(6):476-479.
11. S?rensen B, Tang M, Larsen OH, et al. Te role of fbrinogen:a new paradigm in the treatment of coagulopathic bleeding. Tromb Res, 2011, 128(1):S13-S16.
12. Nomura F, Tamura K, Yoshitatsu M, et al. Changes in coagulation condition, cytokine, adhesion molecule afer repair of type A aortic dissection. Eur J Cardiothorac Surg, 2004, 26(2):348-350.
13. 秦衛, 黃福華, 陳鑫, 等.深低溫停循環聯合順行性腦灌注對患者認知功能的影響.中國胸心血管外科臨床雜志, 2014, 21(1):71-74.
14. Haldenwang PL, Wahlers T, Himmels A, et al. Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients. Eur J Cardiothorac Surg, 2012, 42(5):e115-e120.
15. 舒暢, 張文波.主動脈夾層的降壓藥物治療.中國實用外科雜志, 2011, 31(12):1098-1099.
16. Roh GU, Lee JW, Nam SB, et al. Incidence and risk factors of acute kidney injury afer thoracic aortic surgery for acute dissection. Ann Torac Surg, 2012, 94(3):766-771.
17. 楊勇, 李小密, 李菲, 等.主動脈弓置換術后急性腎損傷發生的危險因素分析.中國胸心血管外科臨床雜志, 2011, 18(2):109-113.
18. 喻磊, 谷天祥, 師恩袆, 等.深低溫停循環腎損傷及其早期檢測.中國胸心血管外科臨床雜志, 2014, 21(1):90-96.
19. Girdauskas E, Kuntze T, Borger MA, et al. Acute respiratory dysfunction afer surgery for acute type A aortic dissection. Eur J Cardiothorac Surg, 2010, 37(3):691-696.
20. 李玉葉, 高占成.肺內外源性急性呼吸窘迫綜合征與細胞因子相關性的研究進展.中國臨床醫生, 2014, 42(2):10-13.
21. del Porto F, Proietta M, Tritapepe L. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8):622-629.
22. 孫博, 劉楠, 邢曉燕, 等.急性Stanford A型主動脈夾層圍術期急性肺損傷與D-二聚體相關性的探討.心肺血管病雜志, 2013, 32(1):26-29.
23. 李茂琴, 李家瓊, 許繼元, 等.反復肺復張聯合肺保護性通氣對急性呼吸窘迫綜合征患者肺損傷的作用.中華臨床醫師雜志(電子版), 2011, 5(15):4377-4380.
24. Achouh PE, Madsen K, Miller CC, et al. Gastrointestinal complications afer descending thoracic and thoracoabdominal aortic repairs:a 14-year experience. J Vasc Surg, 2006, 44(3):442-446.

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