摘要
急性主动脉综合征(Acute Aortic Syndrome,AAS)是以主动脉壁完整性受损为特征的心血管急症,可累及主动脉任意节段,一旦发病病死率极高。目前急诊外科治疗是AAS的首选治疗方案,但是无论即将接受手术还是因为各种原因无法接受手术治疗的患者,均有必要接受非外科治疗。尽管国际指南有推荐的AAS非外科治疗方案,但细节较少,特别是伴有脏器灌注不良时的治疗方案有限,且不同治疗方案的结局差异较大。此外,尽管国内已有高血压急症诊疗的专家共识,对AAS患者血压的管理提供指导,但是尚未涵盖继发脏器灌注不良的处理意见。因此,由国家心血管疾病临床医学研究中心、首都医科大学附属北京安贞医院牵头,联合中国医师协会心血管外科医师分会、中华医学会急诊医学分会成立专家工作组,以多学科协作综合救治为原则,涉及急诊科、危重症医学科、心脏大血管外科、外周血管科、神经内科、消化内科、肾内科、骨科等学科,参考国内外相关指南、共识、论著等文献,结合中国临床实际,制订了一套针对AAS的标准化、规范化的非外科强化治疗方案,旨在全周期、多维度、精准指导非外科治疗的实施,进而改善AAS患者的预后。
Acute Aortic Syndrome(AAS)is a cardiovascular emergency characterized by the disruption of the aortic wall integrity,which can involve any segment of the aorta.Once it occurs,the mortality rate is extremely high.Currently,emergency surgical treatment is the preferred therapeutic approach for AAS.However,both patients who are about to undergo surgery and those who are unable to receive surgical treatment for various reasons need to undergo non-surgical treatment.Although international guidelines recommend non-surgical treatment protocols for AAS,the details are limited,especially regarding treatment options when organ perfusion is impaired.Moreover,the outcomes of different treatment protocols vary significantly.In addition,while China has expert consensus on the diagnosis and treatment of hypertensive emergencies,which can provide guidance for blood pressure management in AAS patients,it does not cover the management of organ perfusion impairment.Therefore,led by the National Clinical Research Center for Cardiovascular Disease and Beijing Anzhen Hospital Affiliated to Capital Medical University,together with the Chinese Association of Cardiovascular Surgeons and the Chinese Society of Emergency Medicine,the expert working group was established.It involved the departments of emergency,critical care medicine,cardiovascular surgery,peripheral vascular surgery,neurology,gastroenterology,nephrology,orthopedics and so on.Referring to the relevant guidelines,consensus,original articles and other literatures,combined with the clinical practice in China,a set of standardized non-surgical intensive treatment plan for acute aortic syndrome was formulated.It aims to guide the implementation of non-surgical treatment in full cycle,multi-dimensional and precise,so as to improve the prognosis of patients with acute aortic syndrome.
出处
《中华胸心血管外科杂志》
2025年第4期193-205,共13页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
国家自然科学基金项目(82241205,82422007,82170487,82270514)
北京市自然科学基金(JQ24039,7232005,24G10071)
北京市科委重点项目(Z221100007422015)
北京市医院管理中心“扬帆”计划诊疗能力提升项目(ZLRL202317)。
关键词
急性主动脉综合征
非外科强化治疗
多学科团队治疗
Acute Aortic Syndrome
Non-Surgical Reinforcement Therapy
Multidisciplinary Team Treatment
