摘要
目的对比分析经胸骨上段小切口David手术与Bentall手术治疗急性A型主动脉夹层(ATAAD)的疗效及安全性。方法选取2022年1月至2023年3月南阳市中心医院收治的107例ATAAD患者作为研究对象,根据手术方式的不同,将其分为观察组(行David手术,45例)和对照组(行Bentall手术,62例)。对比两组患者手术时间、主动脉阻断(ACC)时间、体外循环(CPB)时间等术中情况,术中输注血制品(悬浮红细胞、新鲜冷冻血浆、单采血小板、冷沉淀)人数占比情况以及输血量,比较两组患者术后恢复以及术后并发症发生情况。结果观察组手术时间明显长于对照组(P<0.05),但两组ACC、CPB时间比较,差异无统计学意义(P>0.05);术中两组输注血制品人数占比情况比较,差异无统计学意义(P>0.05),但观察组输注悬浮红细胞、新鲜冷冻血浆量明显低于对照组(P<0.05),两组输注单采血小板、冷沉淀量比较,差异无统计学意义(P>0.05);观察组24h引流量、机械通气时间、ICU停留时间、术后住院时间、疼痛评分均低于对照组(P<0.05),术后死亡人数比较,差异无统计学意义(P>0.05);两组需二次开胸止血、切口感染、心律失常、胸腔积液、急性肾损伤等并发症发生率比较,差异无统计学意义(P>0.05)。结论David手术是一种安全、有效的手术方式,手术创伤小、恢复快,具有一定的推广价值。
【Objective】To analyze the efficacy and safety of David procedure and Bentall procedure via upper mini-sternotomy for acute type A aortic dissection(ATAAD).【Methods】We enrolled 107 patients with ATAAD admitted to Nanyang Central Hospital from January 2022 to March 2023.Based on surgical approach,45 patients underwent the David procedure(observation group)and 62 received the Bentall procedure(control group).Intraoperative parameters[operative time,aortic cross-clamping(ACC)time,cardiopulmonary bypass(CPB)time],transfusion requirements[packed red blood cells(PRBCs),fresh frozen plasma(FFP),platelets,cryoprecipitate],postoperative recovery and incidence of postoperative complications were compared.【Results】The operative time in the observation group was significantly longer than that in the control group(P<0.05),while no significant differences were observed in ACC or CPB time(P>0.05).Although the proportion of patients requiring blood product transfusion was similar between groups(P>0.05),the observation group received significantly less PRBCs and FFP(P<0.05).There was no statistically significant difference in the amount of infused cryoprecipitate and apheresis platelets between the two groups(P>0.05).The observation group also showed advantages in postoperative recovery,with lower 24-h drainage volume,shorter mechanical ventilation time,ICU stay,and hospitalization length,as well as reduced pain scores(all P<0.05).No significant differences were noted in mortality or complications(e.g.,re-exploration for bleeding,incision infection,arrhythmia,pleural effusion and acute kidney injury)(P>0.05).【Conclusion】The David procedure is a safe and effective alternative with minimized trauma and faster recovery,demonstrating notable clinical applicability.
作者
王柯
吕建
张正彬
WANG Ke;IYU Jian;ZHANG Zhengbin(Department of Cardiovascular and Great Vessel Surgery,Nanyang Central Hospital,Nanyang,Henan 473000,China)
出处
《中国医学工程》
2025年第8期42-46,共5页
China Medical Engineering
