Stanford A型主动脉夹层外科围术期处理

目的总结采用升主动脉及全弓替换加支架＂象鼻＂手术治疗Stanford A型主动脉夹层的外科围术期处理经验。方法 43例A型主动脉夹层手术患者,围术期入重症监护室（ICU）进行系统监护。根据主动脉夹层特点,予以相应的治疗,积极防治可能出现的并发症。结果全组住院死亡2例,1例术前合并急性肾功能衰竭,术后9 d死于多脏器功能衰竭;另1例患者术后第1 d发现右侧肢体偏瘫,未清醒,呼吸机支持,昏迷9 d后,死于脑梗死。手术并发症：低氧血症10例,需气管切开呼吸机辅助2例;术后2 d一过性脑功能紊乱6例,以谵妄、兴奋为主,持续48～72 h后恢复;血管吻合口出血二次开胸止血1例;声音嘶哑1例;乳糜胸6例,经禁食及静脉营养支持治疗后治愈。无截瘫及偏瘫发生。结论加强以神经、呼吸、循环、凝血为重点的各系统监护,维持内环境稳定,积极防治各系统可能出现的并发症,可使主动脉夹层患者术后顺利康复。

Perioperative treatment of Stanford type A aorticdissection

Objective To improve the long term outcomes of the surgery for Stanford type A aorticdissection,we performed ascending aorta and total aortic arch replacement combined with transaorticstented graft implantation into the descending aorta for acute type A aortic dissection.This study summarized the clinical experiences on perioperative treatment of aortic dissection.Methods 43 patients with aortic dissection underwent surgery.All patients were cared in intensive care unit.Corresponding treatments were given,possible complications were prevented and treated according to characteristics of aortic dissection.Results There were 2 early hospital deaths,including one renal failure and one cerebrovascular accident.The complications included transient neurologic deficit in 6 cases,hypoxemia in 10 cases,hemorrhage of anastomose which was treated by reoperation in 1 case,hoarseness in 1 case,chylothorax in 6 cases.Conclusion Strengthening each system monitoring focusing on the nervous system,respiratory and circulatory system,and maintaining homeostasis,preventing possible complications are keys to perioperative patients with aortic dissection to recover smoothly.