摘要
目的:分析A型主动脉夹层手术后早期并发症发病情况,探讨与住院病死率的相关性,为制定预防和治疗措施提供依据。方法:2009年2月至2010年10月在我院行主动脉替换术的A型主动脉夹层患者252例的手术资料。手术方案依据细化分型原则制定。根据主动脉根部病变程度分为3型:A1主动脉窦部正常型;A2主动脉窦部轻度受累型;A3主动脉窦部重度受累型。根据主动脉弓部病变分为2型:S型单纯型;C型复杂型。C型采用主动脉弓替换加支架象鼻(孙氏手术)处理。结果:252例患者,平均年龄47岁,男性193例,女性59例。急性夹层187例(发病<2 w),慢性夹层65例。A1S型8例,A2S型7例,A3S型8例,A1C型42例,A2C型90例,A3C型97例。术后早期并发症包括吻合口出血(8例,3.2%);肝功能不全(8例,3.2%);肾功能衰竭(16例,6.3%);急性呼吸功能不全(32例,12.7%);神经系统并发症(37例,14.7%),包括脑部并发症一过性脑功能紊乱(29例,11.5%)、脑梗死(3例,1.2%)和脊髓损伤(5例,2.0%);住院死亡(16例,6.3%)。住院死亡组除吻合口出血外,其余术后并发症的发病率均明显高于非住院死亡组(P<0.05)。多元Logistic回归分析显示脊髓损伤,肾衰竭和肝功能不全是住院死亡的危险因素。结论:A3C型是A型主动脉夹层细化分型的主要类型。术后早期神经系统并发症最为常见。住院病死率与术后早期并发症发病率明显相关,其中脊髓损伤,肾功能衰竭和肝功能不全是导致住院死亡的独立危险因素。
Objective：To define the incidence of early postoperative complications after A type aortic dissection surgery and to clarify the relationship between the incidence of postoperative complications and hospi-tal mortality.Methods：Clinical data of the patients who underwent A type aortic dissection surgery from Febural 2009 to Octorber 2010 were collected.Type A aortic dissection was classified into 3 subtypes based on the path-ological change of the aortic root： A1 meaned no pathological change;A2 meaned mild pathological change;A3 meaned severe pathological change type.Two subtypes were classified based on the pathological change of the aortic arch： C meaned complex type and S meaned simple type.Total arch replacement with stented elephant trunk（Sun＇s technique） was performed in patients with type C.Results：252 patients including 193 males and 59 females were recruitment.The average age was 47 years old.Early stage postoperative complications were at-tributable to reoperation for bleeding（3.2%）,hepatic dysfunction（3.2%）,acute renal failure（6.3%）,a-cute respiratory dysfunction（12.7%）,neurological complications including transient neurological dysfunction（11.5%）,spinal cord injury（2.0%） and stroke（1.2%）,hospital mortality（6.3%）.Except for reopening for bleeding,all the incidence of complications were significant higher in hospital death group（P〈0.05）.Lo-gistic regression analyze showed spinal cord injury,acute renal failure and hepatic dysfunction were independent risk factors of hospital mortality.Conclusion：A3C was the most common subtype of type A aortic dissection.Neurological complications had highest incidence after operation.Early stage postoperative complications were related to hospital mortality.Spinal cord injury,acute renal failure and hepatic dysfunction were independent risk factors of hospital mortality in patients with A type aortic dissection.
出处
《心肺血管病杂志》
CAS
2011年第3期183-186,共4页
Journal of Cardiovascular and Pulmonary Diseases
