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改良全弓置换加支架象鼻术在DeBakeyⅠ型主动脉夹层术中的应用 总被引:2,自引:0,他引:2
目的 总结改良主动脉全弓置换加支架象鼻术治疗DeBakey Ⅰ型主动脉夹层的临床经验.方法 2006年1月至2010年10月,101例DeBakey Ⅰ型主动脉夹层患者接受改良全弓置换加支架象鼻术,其中急诊手术73例.全组男性76例,女性25例;年龄21~77岁,平均(49±8)岁.手术包括升主动脉置换术31例、Bentall术29例、Wheat术7例、David术34例.支架象鼻术的同时行左锁骨下动脉开窗以重建血运.在深低温停循环时改行双侧顺行脑灌注下完成脑保护.结果 手术改良后平均心肺转流时间(212±40)min,平均心肌阻断时间(95±16)min,平均停循环时间(42±8)min.手术死亡1例,住院死亡5例,分别死于感染败血症、急性肾功能衰竭、偏瘫并发多器官功能衰竭.双侧脑灌注后脑血管意外和短暂脑神经功能障碍的发生率低于选择性脑灌注.76例患者出院前复查主动脉CT血管造影,人工血管无扭曲,血流通畅,胸降主动脉夹层假腔闭合率为78.9%.71例随访5~49个月,其中50例复查CT血管造影,胸降主动脉夹层假腔闭合率为88.0%,无晚期死亡及再次手术者.结论 改良的全弓置换加支架象鼻术治疗DeBakey Ⅰ型主动脉夹层安全、有效,可减少术后并发症.Abstract: Objective To summarize the clinical study of modified total aortic arch replacement and stent elephant trunk technique treatment to patients with DeBakey Ⅰ thoracic aortic dissection. Methods From January 2006 to October 2010, 101 cases of DeBakey Ⅰ aortic dissection were treated by modified total arch replacement and stent elephant trunk technique, in which emergency surgery for 73 cases. There were 76 male and 25 female patients, aged from 21 to 77 years with a mean of(49 ±8)years. Intraoperative ascending aortic replacement in 31 cases, Bentall procedure in 29 cases, Wheat procedure in 7 cases, David procedure in 34 cases. At the same time stent elephant trunk in the left subclavian artery corresponding position was windowed to rebuild the blood supply. Deep hypothermic circulatory arrest cerebral protection was completed by bilateral antegrade cerebral perfusion. Results The mean cardiopulmonary bypass time was(212 ±40)min, mean myocardial occlusion time was(95 ± 16)min, mean circulatory arrest time was (42 ±8)min. Operative mortality was 1 case and hospital mortality was 5 case, which died of septicemia,acute renal failure and hemiplegia complicated with multiple organ failure. Compared with selective cerebral perfusion, the incidence of postoperative cerebral vascular accident and transient neurological dysfunction decreased. Seventy-six cases received aorta CTA before discharged, the closure rate of descending thoracic aortic dissection false lumen was 78. 9%. Seventy-one patients were followed up for 5 to 49 months, 50cases was reviewed by CTA, of which closure rate of descending thoracic aortic dissection false lumen was 88.0%, no late death and re-surgery. Conclusions The modified total aortic arch replacement and stent elephant trunk technique treatment for patients with DeBakey Ⅰ thoracic aortic dissection was safe and effective, with less postoperative complications. 相似文献
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我们1980年5月至2010年1月应用急诊体外循环抢救和治疗濒危病31例,效果较好,现报告如下.
临床资料
1.一般资料:本组31例,男21例,女10例,年龄9~65岁.其中气管下段接近完全梗阻15例,动脉导管术中意外破裂2例,右心导管心内折断1例,介入治疗房间隔缺损中伞脱落1例,人工心瓣膜失灵1例,食管感染、食管-主动脉瘘2例,右心房巨大肿瘤破裂急性心脏压塞1例,心脏瓣膜置换术后再发心泵衰1例,心脏黏液瘤球瓣效应致急性心功能衰竭2例,主动脉窦瘤破裂急性心泵衰2例,外伤性主动脉弓降部破裂2例,升主动脉瘤破裂1例. 相似文献
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目的:研究红细胞(RBC)抗氧化活性作为心肺转流术(CPB)患者氧化应激反应水平指标的可行性。方法:8例行主动脉-冠状动脉搭桥术的患者,分别于不同时相测定其中心静脉血中RBC抗氧化物丙二醛(MDA)和血浆游离异前列腺素15-F2t-Isoprostane(15-F2t-Imp)浓度。结果:在CPB和缺血再灌注损伤(IRI)过程中MDA产生明显增加,血浆游离15-F2t-Isop浓度显著增高,两者间存在明显正相关。结论:在CPB过程中,RBC抗氧化活性反映了机体氧化应激状态,是评价患者CPB时体内氧化应激水平的良好指标。 相似文献
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男性患者,54岁,诊断终末期心脏病。在静脉复合麻醉低温体外循环下行同种异体原位心脏移植。笔者对体外循环的体会:①适当的血液稀释及维持一定的胶体渗透压;②良好的心脏保护;③防止脏器组织水肿和减轻炎性介质反应。 相似文献
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目的总结高龄患者行冠状动脉搭桥手术体外循环(cardiopulmonary bypass,CPB)管理的经验。方法行冠状动脉搭桥手术患者48例,其中70岁以上者28例(高龄组),70岁者20例(非高龄组),回顾性比较两组的CPB差异。结果高龄组患者术前更易合并糖尿病,术前HCT较低(P<0.05)。高龄组体外循环时间(135.6±17.3)min,升主动脉阻断时间(101.3±40.2)min,术后改良超滤10例,与非高龄组相比较,差异有显著性;高龄组应用库血预充占82.1%(23/28),明显高于非高龄组的25%(P<0.01),升主动脉开放后,高龄组自动复跳24例(85.7%),非老年组自动复跳17例(85%),两组比较无差异;但高龄组有3例停CPB后需IABP辅助脱机。结论高龄并非心脏手术CPB的禁忌症,根据其患病特点,合理地行CPB管理,可以为高龄患者成功地进行冠状动脉搭桥手术提供重要保证。 相似文献