急性主动脉夹层腔内隔绝术围手术期死亡的临床分析

目的分析急性主动脉夹层腔内隔绝术围手术期死亡的原因。方法对2001年7月至2012年10月期间笔者所在医院行腔内隔绝术治疗的176例急性主动脉夹层患者的临床资料进行回顾性分析。结果176例患者中围手术期死亡8例，8例患者入院后至手术时间为1～5d，平均2.4d。其中A型2例，B型6例，均系2008年前收治者；8例死亡病例均伴有高血压，3例伴有胸腔积液。围手期死亡病例发生在手术当天3例，其中2例发生在术后1h内，另1例发生在术后2h；术后2d死亡4例；术后4d死亡1例。死于主动脉破裂4例，脑梗塞2例，多器官功能衰竭1例，消化道出血1例。结论避免急性期行腔内隔绝术以及提高操作技能将有助于避免围手术期死亡的发生。

Clinical Analysis on Perioperative Death of Endovascular Repair for Acute Aortic Dissection

Objective To analyze the reasons for the perioperative death of endovascular repair of acute aortic dissection （AD）. Methods The clinical data of 176 patients with acute AD and received endovascular repair from July 2001 to October 2012 were analyzed retrospectively. Results Among 176 patients with acute AD, 8 patients died during perioperatively, received endovascular repair in 1-5 days after admission （mean 2.4 d）, and all of them admitted before 2008. Two cases were type A and 6 cases were type B. All cases with hypertension and 3 cases with pleural effusion. Three cases died on the day of operation, among them 2 cases occurred in 1 h after operation, the other I case occurred in 2 h after operation. Four cases died in 2 days after operation and 1 case died in 4 days after operation. Four cases died of rupture of the aortic dissection, 2 cases died of cerebral infarction, 1 case died of multiple organ failure, and 1 case died of gastrointestinal bleeding. Conclusion To avoid performing endovascular repair during the acute phase and improving operation skills may help to avoid the occurrence of perioperative death.