本文已被:浏览 2516次 下载 4082次
Received:May 03, 2018 Published Online:December 20, 2018
Received:May 03, 2018 Published Online:December 20, 2018
中文摘要: 目的 研究DeBakeyⅠ型主动脉夹层无深低温停循环手术的临床疗效及并发症发生情况。 方法 选择2014年1月至2017年1月邯郸市中心医院收治的DeBakeyⅠ型主动脉夹层患者50例作为研究对象进行回顾性研究。按照不同停循环方法分为两组,研究组20例患者采用无深低温停循环手术,对照组30例患者行深低温停循环手术。分别记录两组患者的体外循环(CPB)时间、升主动脉阻断时间、脑灌注时间、不同时间点氧合指数、术后引流量、ICU时间、住院时间;并统计两组患者术后出现的不良情况。 结果 研究组的CPB时间为(179.9±61.2)min,升主动脉阻断时间为(86.2±27.9)min,脑灌注时间为(51.9±11.5)min,均稍低于对照组的(205.5±64.5)min、(93.1±25.2)min、(53.6±13.2)min,但组间差异无统计学意义(P>0.05)。CPB结束时、结束后2 h及结束后4 h,两组的氧合指数均呈下降趋势,但相同时间点,对照组氧合指数低于观察组(P<0.01);在CPB结束后8 h,两组氧合指数都较CPB值术后2 h、4 h上升(P<0.05),且研究组高于对照组(P<0.01)。研究组患者的引流液量为(780.72±151.56) ml、使用呼吸机时间为(11.95±3.72)h、ICU时间为(2.21±1.47)d、住院时间为(13.25±3.41)d,均显著低于对照组的(1 006.12±341.87)ml、(14.76±4.13)h、(3.19±1.23)d、(15.68±3.72)d,差异具有统计学意义(P<0.01,P<0.05)。研究组患者出现二次开胸1例、意识障碍1例、昏迷0例、死亡0例;对照组二次开胸4例、意识障碍5例、昏迷2例、死亡3例,两组患者的术后不良情况比较差异无统计学意义(P>0.05)。 结论 DeBakeyⅠ型主动脉夹层手术中应用无深低温停循环,较深低温停循环手术可有效减少术后引流量以及住ICU、使用呼吸机和住院的时间,提高CPB结束后氧合指数,有利于降低术后并发症。
中文关键词: 主动脉夹层 深低温停循环 心脏停搏液 主动脉弓部置换;体外循环;氧合指数,术后并发症
Abstract:Objective To investigate the clinical efficacy of operation without deep hypothermic circulatory arrest for DeBakey Ⅰ aortic dissection. Methods Fifty patients with DeBakey Ⅰ aortic dissection admitted in Handan Central Hospital from January 2014 to January 2017 were selected as research objects. The patients were divided into two groups according to different circulatory arrest methods: study group (n=20, without deep hypothermic circulatory arrest) and control group (n=30, with deep hypothermic circulatory arrest). The operation was performed under cardiopulmonary bypass (CPB) in both two groups. CPB time, ascending aorta crossclamp time, cerebral perfusion time, oxygenation index at different time points, amount of postoperative drainage, length of ICU stay, length of hospital stay were recoded, and postoperative adverse conditions were counted. Results CPB time [(179.9±61.2) min], ascending aorta crossclamp time [(86.2±27.9) min] and cerebral perfusion time [(51.9±11.5) min] in study group were all lower than those in control group [(205.5±64.5) min, (93.1±25.2) min and (53.6±13.2) min], while there were no significant differences in them between two groups (all P>0.05). At the end of CPB, 2 hours after end of CPB and 4 hours after end of CPB, the oxygenation indexes showed a downward trend in two groups, but they at same time points in control group were all significantly lower than those in study group (all P<0.05). The oxygenation indexes increased significantly 8 hours after end of CPB in both two groups, and it in study group was significantly higher than that in control group (P<0.05). The amount of postoperative drainage [(780.72±151.56) ml], ventilator use time [(11.95±3.72) h], length of ICU stay [(2.21±1.47) d] and length of hospital stay [(13.25±3.41) d] in study group were all significantly lower than those [(1 006.12±341.87) ml, (14.76±4.13) h, (3.19±1.23) d and (15.68±3.72) d] in control group (all P<0.05). The re-thoracotomy operation, disturbance of consciousness, coma and death were found in 1 case, 1 case, 0 case, 0 case, respectively in study group and in 4 cases, 5 cases, 2 cases, 3 cases, respectively in control group, while there were no significant differences in them between two groups (P>0.05). Conclusion Application of circulatory arrest without deep hypothermia can effectively reduce amount of postoperative drainage, ventilator use time, length of ICU stay and length of hospital stay, improve oxygenation index after end of CPB and is in favor of the decrease of postoperative complications compared with the method without deep hypothermic circulatory arrest in the operation of DeBakey type Ⅰ aortic dissection.
keywords: Aortic dissection Deep hypothermic circulatory arrest Cardioplegia solution Aortic arch replacement Cardiopulmonary bypass Oxygenation index Postoperative complication
文章编号: 中图分类号: 文献标志码:A
基金项目:河北省科技计划项目(162777298)
引用文本: