右心房分流术在主动脉根部手术中的应用

目的总结右心房分流术在主动脉根部手术中的应用经验，并评价其安全性和疗效。方法对26例在医院接受主动脉根部手术治疗的患者（A组），采用残余主动脉血管片或自体心包片缝合包裹人造血管及吻合口，并与右心耳部行吻合，建立与右心房间的交通，将人造血管及各吻合口渗血引流入右心房内；并与同时间段未行右心房分流术的21例主动脉根部疾病患者（B组）进行对比研究。结果两组患者的主动脉阻断时间和术后住院时间比较，差异无统计学意义（P〉0.05）。与B组相比，A组手术时间和体外循环时间缩短，术中失血量少，术后第1d心包和纵隔引流量以及术后总引流量少，输入血液制品量少，差异有统计学意义（P〈0．05）。A组出院前超声心动图检查提示主动脉根部与右心房间无血流流动，主动脉CTA检查显示主动脉根部与右心房间分流通道内有血检形成。结论右心房分流术操作简单、安全，可以有效减少主动脉根部手术后出血，减少出血相关并发症，显著改善主动脉根部手术的临床效果，值得推广应用。

Application study of right atrial shunt in aortic root operation

Objective To summarize the clinical experience of right atrial shunt in aortic root operation, and to assess its security and effectiveness. Methods A chamber around the aortic grat was created by suturing residual aortic piece or a patch of autologous pericardium for 26 patients underwent aortic root operation from January 2007 to December 2011（Group A）, and then the chamber was communicated with the right atrium to drain capillary hemorrhage from the root stoma. At the same period, right atrial shunt wasn＇t used for 21 patients underwent aortic root operation（Group B）. A comparative study was clone between two groups. Results The differences of the aortic cross clamp time and the postoperative hospital stay in two groups were not significant statistically（p〉0. 05）. Compared with Group B, the oper- ation time and the eardiopulmonary bypass time in Group A was shorter, the intraoperative blood loss volume was less, the postoperative pericardial and mediastinal drainage volume at the first day and the total postoperative drainage volume were less, and the blood transfusion volume was less（P〈0.05）. No blood flow from aortic root to right atrium was detected by color Doppler eehoeardiography examination, and thrombosis was found in the shunt passage by aortic computed tomography angiography examination before discharge in Group A. Conclusion Right atrial shunt is simple and safe. It can reduce bleeding and complications associated with bleeding effectively, and improve the clinic effect markedly in aortic root operation. It should be extended in clinic.