胸主动脉夹层术后监护与治疗

目的 总结胸主动脉夹层术后监护与治疗的临床经验.方法 134例行胸主动脉夹层手术患者,术后入重症监护室(ICU)进行系统监护.根据患者的各系统状况和主动脉夹层特点,给予相应的支持对症治疗,尽早积极有效地防治可能出现的并发症.结果 平均ICU停留时间(78±53)h;术后死亡5例;一过性脑功能紊乱19例,延迟苏醒1例,脑血管意外3例,截瘫1例;低氧血症31例;心肌缺血1例,室性心律失常2例;术后肾功能衰竭1例;血管吻合口出血二次开胸止血4例;术后感染3例.结论 术后加强各系统的监护,尽早对高危因素分析与评估,有效预防、积极处理各系统并发症,是胸主动脉夹层患者顺利康复的保障.     

主动脉夹层动脉瘤手术病人的监护

主动脉夹层动脉瘤是一种心血管危急重症 ,常起病急骤、症状复杂、预后差、病死率高。手术治疗是清除病灶、防止动脉破裂及脏器缺血等并发症的主要方法。我院 1995年 5月至 2 0 0 2年 2月为 6 8例主动脉夹层动脉瘤病人施行手术 ,其监护要点介绍如下。1　临床资料6 8例中 ,男 5 5例、女 13例 ,年龄 1973岁 ,平均 (43.2±13.2 )岁。病程 12ｈ至 11年。其中动脉粥样硬化 2 6例 ,先天性主动脉夹层动脉瘤 3例 ,马凡氏综合征 39例。有高血压病史者 38例 ,占 5 5 .9%。心功能Ⅳ级 15例、Ⅲ级 2 6例、Ⅱ级 2 0例、Ⅰ级 7例。病人均在中深低温体外循环…     

主动脉夹层术后消化道出血的诊断与治疗

目的 探讨主动脉夹层术后消化道出血诊断策略和治疗选择。方法 回顾性分析2020年1月～2022年6月我院行主动脉夹层术后出现消化道出血的临床资料。结果 14例主动脉夹层术后消化道出血病人中共治愈10例，7例以基础支持和药物治疗为主，1例采用内镜下止血治疗，2例采用外科手术；未治愈病人中，3例为基础支持和药物治疗，外科手术治疗效果不佳出现1例死亡病例。结论 主动脉夹层术后消化道出血的诊疗策略应根据出血量、部位和并发症情况进行综合评估，采用个体化治疗。适时的手术治疗有助于改善主动脉夹层术后消化道出血病人的预后与转归。     

主动脉夹层患者人造血管置换术后的监护

目的观察间苯三酚与氧化亚氮联合应用于第一产程活跃期的效果.方法将120例初产妇随机分为间苯三酚与氧化亚氮联合应用组(观察1组,40例),单用间苯三酚组(观察2组,40例)和不用药物组(对照组,40例).结果间苯三酚可显著缩短活跃期时间(P＜0.01),间苯三酚与氧化亚氮联合应用既可明显缩短活跃期时间,还可达到良好的分娩镇痛疗效(P＜0.01).应用间苯三酚和氧化亚氮后产后2小时出血量、新生儿评分无显著改变(均P＞0.05).结论间苯三酚与氧化亚氮联合应用于第一产程活跃期有明显的缩短产程和镇痛作用.     

主动脉夹层患者人造血管置换术后的监护

对33例主动脉夹层患者施行人造血管置换术,术后监护(6.3±4.3)d.结果32例治愈出院,1例死于多脏器功能衰竭.提出术后加强各系统功能监护,加强呼吸道管理,保持气道通畅,正确排痰,做好气管插管护理,保证体液平衡及合理的营养支持是促进患者术后功能恢复的主要保障.     

主动脉夹层的神经系统并发症

主动脉夹层是一类可能威胁生命的血管性疾病.除了夹层破裂和心包填塞以外,其主要的威胁来自于夹层累积范围内所致的各分支动脉缺血所引发的并发症.各靶器官受累几率为:四肢10%～20%,肾脏15%,心肌10%,脑5%～15%,肠道及脊髓3%[1].其中神经系统缺血由于起病隐匿、症状复杂多变以及处理的困难,被认为是主动脉夹层中最为棘手的并发症.这些并发症可发生于主动脉夹层的自然病程中,更可能发生于手术治疗之后.本文结合我们在近年来在Stanford B型主动脉夹层诊治过程中的经验,对其神经系统并发症加以整理和总结.     

主动脉夹层瘤术后预防脑部神经系统并发症的系统护理

目的探讨优质护理在主动脉夹层瘤术后预防脑部神经系统并发症的效果。方法对60例接受孙氏手术的主动脉夹层动脉瘤患者术后实施预防神经系统并发症的系统护理。结果本组术后发生神经系统并发症8例(15.00%),其中暂时性神经功能障碍5例,遵医嘱应用神经细胞营养药物、抗精神病药、糖皮质激素等治疗后痊愈。永久性神经功能障碍3例(2.0%),转入神经康复科继续下一阶段治疗。2例患者分别死于脑出血引起的脑疝和多器官功能衰竭。未发生癫痫等其他脑部神经系统并发症。术后住院时间18~27 d,平均22.52 d,55例患者顺利康复出院。结论对动脉夹层瘤手术患者术后严密观察意识水平、瞳孔反应、运动功能变化。做好脑部神经系统功能的评估和心理、用药护理等系统干预,可有效降低神经系统并发症的发生率,改善患者的康复效果。     

主动脉夹层腔内修复术后并发症及其处理

1994年Dake等[1]首次将支架型人工血管用于胸主动脉瘤的治疗,并于1999年实施了Stanford B型主动脉夹层腔内修复术[2].与传统开胸手术相比,腔内修复具有创伤小、恢复快等多项优点,其安全性和有效性已获证实.但是随着腔内治疗经验的增加,内漏、逆行性A型夹层等并发症已逐渐得到重视.本文将对主动脉夹层腔内治疗后并发症类别及诊治进展作一总结.     

A型主动脉夹层术后消化道出血危险因素的回顾性队列研究

目的 探讨A型主动脉夹层患者术后消化道出血(gastrointestinal bleeding,GIB)的危险因素,并讨论其预防和治疗方法。方法 回顾性分析2017—2021年海军军医大学附属第一医院心血管外科收治的A型主动脉夹层术后患者的临床资料。根据术后是否存在GIB将患者分为GIB组和non-GIB组。将两组差异有统计学意义的单变量纳入多因素logistic回归模型,分析A型主动脉夹层患者术后GIB的危险因素。结果 GIB组纳入患者18例[男12例、女6例,平均年龄(60.11±10.63)岁],non-GIB组纳入患者511例[男384例、女127例,平均年龄(49.81±12.88)岁]。单因素分析中,两组患者的年龄、术前经皮动脉血氧饱和度(percutaneous arterial oxygen saturation,SpO₂)<95%、术中停循环时间、术后低心排血量综合征、撤除呼吸机时间>72 h、术后吸入气氧浓度(FiO₂)≥50%、连续性肾脏替代治疗(continuous renal replacement th...     

Stanford B型主动脉夹层腔内治疗术后中远期并发症的治疗

目的探讨Stanford B型主动脉夹层腔内修复术(TEVAR)后中远期严重并发症的治疗及预防经验。方法分析2008年6月至2014年3月本院治疗的44例Stanford B型主动脉夹层TEVAR术后发生严重并发症患者的资料。结果主要并发症包括内漏、支架远端内膜撕裂、逆行夹层、脑梗死、支架移位、支架植入假腔、下肢缺血以及支架断裂。治疗方法为再次TEVAR治疗或开放手术治疗。34例患者痊愈,10例患者未愈。术后30天死亡率为2.3%(1/44)。随访时间2~45个月,平均23.5个月,并发症的总死亡率为6.8%(3/44)。死亡原因为脑梗死及主动脉瘤破裂。结论 TEVAR治疗Stanford B型主动脉夹层导致的并发症有不同的后续治疗问题。严格的术前评估,合适的支架选择及专业化的腔内手术技术能够减少这些并发症的发生。     

Stanford B型夹层腔内修复术后并发逆行性A型夹层的分型与防治

<正>1背景自上世纪末Dake等[1]和Nienaber等[2]在新英格兰医学杂志同期报道腔内修复(thoracic endovascularaortic repair,TEVAR)治疗Stanford B型夹层的良好效果以来,经过10余年的发展,TEVAR微创、安全、有效的优点得到广泛认可,开展病例数不断增多。同时,随着腔内器材研制的快速发展,医生腔内     

关于Stanford B型主动脉夹层腔内修复术后中远期并发症的若干问题

主动脉夹层(aortic dissection,AD)的发病率和检出率正逐年上升.据统计,每年以胸腹痛症状到急诊就医的患者中约0.5%被确诊为AD[1].AD可导致主动脉瘤样扩张、动脉壁破裂、内脏器官和肢体缺血等并发症,若不治疗,病死率可达80%,严重危及患者生命安全.传统的外科手术因创伤巨大,围手术期病死率和截瘫率同样较高.自支架型人工血管成功应用于Stanford B型主动脉夹层修复以来,B型夹层的腔内修复术(thoracic endovascular aneurysm repair,TEVAR)迄今已有逾10年的发展.     

Stanford A型主动脉夹层的腔内修复术后并发症分析

目的总结Stanford A型主动脉夹层(TAAD)腔内修复术后常见并发症的诊治经验。方法对2001年1月至2012年5月接受腔内治疗的58例TAAD患者资料进行回顾性分析。平均年龄54.3(41～79)岁。35例单纯接受腔内治疗,23例接受杂交手术:升主动脉-左颈总动脉-左锁骨下动脉旁路3例,左颈总动脉-左锁骨下动脉旁路3例,右颈总动脉-左颈总动脉旁路15例,左锁骨下动脉-左颈总动脉-右颈总动脉旁路2例。结果总技术成功率为98.3%(57/58)。并发症包括内漏14例,脑卒中5例,支架源性新破口1例,血管旁路术后吻合口假性动脉瘤2例。术后30天内死亡7例。随访(35.5±5.4)个月,随访期间死亡2例,其余患者均健康生存。结论 TAAD腔内治疗后并发症较累及降主动脉疾病的腔内修复术更为常见,脑卒中是重要的致死性并发症,应引起足够重视。     

Stanford type A aortic dissection with intimal intussusception

A 51-year-old man presented with acute chest pain and loss of consciousness. Computed tomography showed no intimal flap in the ascending aorta and clear dissection involving the aortic root and arch, as well as the descending aorta. At surgery, the intimal tear was found to be circumferential and dissection extended to the proximal aortic arch with intussusception of the intimal layer. Emergency graft replacement of the ascending aorta was performed successfully and his postoperative course was uneventful.     

Repeat surgical intervention after aortic repair for acute Stanford type A dissection

Objective

This study aimed to evaluate the outcomes of repeat interventions on the aorta and aortic valve after surgery for acute Stanford type A aortic dissection.

Methods

The hospital records of patients who underwent repeat surgical intervention between April 2011 and March 2017 for late complications after acute type A aortic dissection repair were retrospectively reviewed.

Results

We identified 17 patients with mean age of 62?±?8 years; 13 were men. The mean interval from the initial emergency aortic repair to the repeat intervention was 5.8?±?5.4 years (range 133 days–16.6 years). Ten patients had dilatation or rupture of the residual type B aortic dissection; six of them had retrograde type A aortic dissection at the onset and did not undergo resection of the primary entry. Five patients had a pseudoaneurysm at the anastomosis; four of them were receiving anticoagulation medication. Three patients had aortic regurgitation; two of them were associated with the gelatin-resorcinol-formaldehyde glue that was used during the initial surgery. There was no early mortality after repeat intervention and no late death after a mean follow-up period of 3.3?±?2.0 years.

Conclusions

Repeat surgical intervention on the aorta and aortic valve after repair of acute type A aortic dissection had favorable early and mid-term outcomes and was not associated with early or late death. Long-term follow-up with imaging and echocardiography was considered to be essential for early detection of residual type B dilatation, anastomotic pseudoaneurysm, and aortic regurgitation after initial aortic repair.

     

Recent advance in treatment of Stanford type A aortic dissection

During the period between November 1986 and November 1988, 13 consecutive patients with Stanford type A aortic dissection (8 acute and 5 chronic) were treated as follows: (1) urgent operation for cases with pericardial tamponade or severe heart failure, (2) initial medical treatment followed by elective operation for acute but stable cases or chronic cases, and (3) routine use of open distal anastomosis or selective cerebral perfusion. One patient died during medical treatment: 5 patients were operated on emergently. The remaining 2 acute and 5 chronic cases were operated on electively. There were no operative deaths, neurological disturbances, or late deaths. It is suggested that acute dissection of the ascending aorta requires immediate surgical intervention, especially when the entry is in the ascending aorta. On the other hand, it is also suggested that one could avoid emergency operations in selected cases with retrograde extension of the aortic dissection.