| 摘要: |
| ［摘要］ 目的 分析股动脉联合无名动脉、左颈总动脉插管在手术治疗急性A型主动脉夹层(ATAAD)患者中的临床效果。方法 选择2021年4月至2022年4月在安徽医科大学附属省立医院行手术治疗的ATAAD患者62例，其中26例行股动脉+无名动脉+左颈总动脉三动脉插管方法建立体外循环（CPB）者为观察组，36例采用股动脉+无名动脉的双动脉插管方法建立CPB者为对照组。比较两组术前、术中及术后早期的临床资料。结果 与对照组相比，观察组停循环时间更短，但术中出血量较多，差异有统计学意义（P<0.05）。观察组术后苏醒时间、呼吸机停用时间、胸管拔除时间快于对照组，重症监护时间、术后住院时间短于对照组，脑部并发症、肾功能不全发生率低于对照组，术后当日引流量多于对照组，差异有统计学意义（P<0.05）。对照组术后二次开胸止血3例（8.33%），术后30 d内死亡3例（8.33%）；观察组无术后二次开胸止血病例，术后30 d内死亡1例（3.85%），两组比较差异无统计学意义（P>0.05）。结论 在手术治疗ATAAD中，通过股动脉+无名动脉+左颈总动脉插管可安全、有效地建立CPB，能在保证术中脑部充足血供的同时降低停循环时间，降低术后并发症的发生风险，缩短术后住院时间，改善患者预后，值得在临床推广。 |
| 关键词: 急性A型主动脉夹层 主动脉夹层手术 体外循环 动脉插管 脑保护 |
| DOI：10.3969/j.issn.1674-3806.2022.07.13 |
| 分类号:R 605 |
| 基金项目: |
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| An analysis on the clinical effect of femoral artery combined with innominate artery and left common carotid artery cannulation on treatment of patients with acute type A aortic dissection |
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WANG Chen, GE Jian-jun
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Department of Heart and Great Vessel Surgery, Provincial Hospital Affiliated to Anhui Medical University, Hefei 230001, China
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| Abstract: |
| ［Abstract］ Objective To analyze the clinical effect of femoral artery combined with innominate artery and left common carotid artery cannulation on treatment of patients with acute type A aortic dissection(ATAAD). Methods Sixty-two ATAAD patients who underwent surgical treatment in Provincial Hospital Affiliated to Anhui Medical University from April 2021 to April 2022 were selected. Among the 62 patients, 26 patients undergoing the 3-arterial cannulation of femoral artery+innominate artery+left common carotid artery to establish cardiopulmonary bypass(CPB) were selected as the observation group, and 36 patients undergoing the double-arterial cannulation of femoral artery+innominate artery to establish CPB were selected as the control group. The preoperative, intraoperative and early postoperative clinical data were compared between the two groups. Results Compared with the control group, the observation group had shorter circulatory arrest time and greater intraoperative blood loss, and the differences were statistically significant(P<0.05). The postoperative recovery time, ventilator deactivation time and chest tube removal time in the observation group was shorter than that in the control group, and the intensive care time and postoperative hospitalization time in the observation group was shorter than that in the control group, and the incidence rates of brain complications and renal insufficiency in the observation group were lower than those in the control group, and the drainage volume on the day after operation in the observation group was greater than that in the control group, and the differences were statistically significant(P<0.05). In the control group, there were 3 cases(8.33%) with secondary thoracotomy for hemostasis, and 3 cases(8.33%) died within 30 days after operation. In the observation group, there were no cases with secondary thoracotomy for hemostasis, and 1 case(3.85%) died within 30 days after operation, and there was no significant difference between the two groups(P>0.05). Conclusion In the surgical treatment of ATAAD, CPB can be safely and effectively established through the cannulation of the femoral artery+innominate artery+left common carotid artery, which can ensure sufficient blood supply to the brain during the operation while reducing the time of circulatory arrest and the risk of postoperative complications, shortening the postoperative hospitalization time, and improving the prognosis of the patients, which is worthy of clinical promotion. |
| Key words: Acute type A aortic dissection(ATAAD) Aortic dissection surgery Cardiopulmonary bypass(CPB) Artery cannulation Brain protection |
