Stanford A型主动脉夹层术后早期的急性肺损伤

目的 探讨Stanford A型主动脉夹层术后早期的急性肺损伤.方法 回顾性分析2006年1月至2013年3月对30例StanfordA型主动脉夹层患者行手术治疗,其中21例患者行全弓置换＋象鼻支架置入手术治疗,9例患者行三分支覆膜支架重建主动脉弓部手术治疗.记录手术前、手术结束时、入ICU时动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）及吸入氧浓度（FiO2）,计算肺泡-动脉血氧分压差（A-aDO2）、氧合指数（OI）,分析术后早期肺通气及氧合功能的变化.结果 A-aDO2、OI两指标手术前、手术结束、入ICU时比较,差异均有统计学意义[（112.47 ±41.06）、（136.13 ±29.51）、（141.37±25.94）mmHg,（535.23±70.15）、（491.50±73.12）、（387.33 ±91.32） mmHg;F值分别为35.926、323.742;P值均为0.000]；A-aDO2、OI两指标入ICU时与术前比较,差异均有统计学意义（P均＜0.05）,与手术结束时比较,差异均有统计学意义（P＜0.01,P＜0.05）.结论 Stanford A型主动脉夹层患者术后早期肺氧合及交换功能均受到一定损害,A-aDO2、OI可作为敏感指标为该类患者术后早期的急性肺损伤提供诊治依据.

Early acute lung injury following Stanford A aortic dissection

Objective To investigate the clinical biomarkers of acute lung injury（ALI） after the Stanford A aortic dissection.Methods Thirty patients underwent Stanford A aoatic dissection were selected as subjects,who hospitalized from January 2006 to March 2013.Of which,21 patients underwent total arch replacement with stented elephant trunk procedure and 9 patients underwent triple-branched stent graft placement.The general information of patients,preoperation echocardiogram data,and arterial partial pressure of oxygen （PaO2）,partial pressure of carbon dioxide （PaCO2） and fraction of inspired oxygen（FiO2） were recorded before,after the operation and entering ICU.Alveolar-arterial oxygen difference （A-aDO2）,oxygenation index （OI） were calculated.Results A-aDO2 and OI at preoperation,postoperative and entering ICU point were （112.47 ±41.06） mmHg,（136.13 ± 29.51） mmHg and （141.37 ± 25.94） mmHg; （535.23 ± 70.15） mmHg; （491.50 ± 73.12） mmHg and （387.33 ± 91.32） mmHg respectively,and the differences were significant （F=35.926,323.742;P =0.000）.The levels of A-aDO2 and OI at entering ICU were significant different from that of pre-operation and post-operation （P ＜ 0.01,P ＜ 0.05）.Conclusion Early postoperative oxygenation and switching functions of patients with Stanford A aortic dissection are subject to damage to some degree.The A-aDO2 and OI might be sensitive biomarkers of the diagnosis for early acute lung injury of aortic dissection patients.